Provider Demographics
NPI:1376295691
Name:OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC
Entity Type:Organization
Organization Name:OPEN AND AFFORDABLE DENTAL COMMERCE CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAKTINSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-260-9582
Mailing Address - Street 1:4972 E 62ND AVE UNIT B1
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-3253
Mailing Address - Country:US
Mailing Address - Phone:303-288-4969
Mailing Address - Fax:303-288-4969
Practice Address - Street 1:4972 E 62ND AVE UNIT B1
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-3253
Practice Address - Country:US
Practice Address - Phone:303-288-4969
Practice Address - Fax:303-288-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000161964Medicaid