Provider Demographics
NPI:1174844955
Name:SOUTH DENVER DENTAL GROUP LLP
Entity Type:Organization
Organization Name:SOUTH DENVER DENTAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-733-0138
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-733-0138
Mailing Address - Fax:303-733-6406
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 375
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-733-0138
Practice Address - Fax:303-733-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty