Provider Demographics
NPI:1376761320
Name:DESIMONE, D MICHAEL I (DMD)
Entity Type:Individual
Prefix:DR
First Name:D MICHAEL
Middle Name:
Last Name:DESIMONE
Suffix:I
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 MALETA LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108
Mailing Address - Country:US
Mailing Address - Phone:303-814-9899
Mailing Address - Fax:303-814-3887
Practice Address - Street 1:718 MALETA LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108
Practice Address - Country:US
Practice Address - Phone:303-814-9899
Practice Address - Fax:303-814-3887
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice