Provider Demographics
NPI:1407929862
Name:DRAGONFLY HOLDINGS PROFESSIONAL LLC
Entity Type:Organization
Organization Name:DRAGONFLY HOLDINGS PROFESSIONAL LLC
Other - Org Name:DAYTON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-752-2777
Mailing Address - Street 1:2020 SOUTH PARKER ROAD SUITE F
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231
Mailing Address - Country:US
Mailing Address - Phone:303-752-2777
Mailing Address - Fax:303-752-2780
Practice Address - Street 1:2020 SOUTH PARKER ROAD SUITE F
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231
Practice Address - Country:US
Practice Address - Phone:303-752-2777
Practice Address - Fax:303-752-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty