Provider Demographics
NPI:1326653841
Name:NIC - DENVER, PLLC
Entity Type:Organization
Organization Name:NIC - DENVER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-459-5517
Mailing Address - Street 1:8000 E PRENTICE AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2725
Mailing Address - Country:US
Mailing Address - Phone:720-459-5517
Mailing Address - Fax:
Practice Address - Street 1:8000 E PRENTICE AVE STE A3
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2725
Practice Address - Country:US
Practice Address - Phone:720-459-5517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental