Provider Demographics
NPI:1568629996
Name:JEFFREY H. WURSTEN D.M.D. P.C.
Entity Type:Organization
Organization Name:JEFFREY H. WURSTEN D.M.D. P.C.
Other - Org Name:ARVADA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARDISON
Authorized Official - Last Name:WURSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-420-1199
Mailing Address - Street 1:6010 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4969
Mailing Address - Country:US
Mailing Address - Phone:303-420-1199
Mailing Address - Fax:720-377-0483
Practice Address - Street 1:6010 KIPLING ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4969
Practice Address - Country:US
Practice Address - Phone:303-420-1199
Practice Address - Fax:720-377-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04957229Medicaid