Provider Demographics
NPI:1407443377
Name:FIRST CHOICE DENTAL 2, PROFESSIONAL LLC
Entity Type:Organization
Organization Name:FIRST CHOICE DENTAL 2, PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAMEEDH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDULAMEER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSC, BDS
Authorized Official - Phone:720-352-2333
Mailing Address - Street 1:10963 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4721
Mailing Address - Country:US
Mailing Address - Phone:720-352-2333
Mailing Address - Fax:
Practice Address - Street 1:2221 S PARKER RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3482
Practice Address - Country:US
Practice Address - Phone:303-320-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28821351Medicaid
CO34000259Medicaid
CODEN00201910OtherSTATE LICENSE
CODEN201918OtherSTATE LICENSE