Provider Demographics
NPI:1417452806
Name:THE DENVER DENTISTS
Entity Type:Organization
Organization Name:THE DENVER DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DDS
Authorized Official - Phone:720-634-6221
Mailing Address - Street 1:2190 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1126
Mailing Address - Country:US
Mailing Address - Phone:720-634-6221
Mailing Address - Fax:
Practice Address - Street 1:2190 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1126
Practice Address - Country:US
Practice Address - Phone:720-634-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN10283261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental