Provider Demographics
NPI:1467709428
Name:ADVANCED FAMILY DENTAL
Entity Type:Organization
Organization Name:ADVANCED FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-985-8000
Mailing Address - Street 1:2598 S LEWIS WAY STE 3C
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-2292
Mailing Address - Country:US
Mailing Address - Phone:303-985-8000
Mailing Address - Fax:303-985-8099
Practice Address - Street 1:2598 S LEWIS WAY STE 3C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-2292
Practice Address - Country:US
Practice Address - Phone:303-985-8000
Practice Address - Fax:303-985-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1033366760OtherDENTAL
CO1225325558OtherDENTAL