Provider Demographics
NPI:1578789319
Name:JOSEPH G ABOOD, JR, DDS, PC
Entity Type:Organization
Organization Name:JOSEPH G ABOOD, JR, DDS, PC
Other - Org Name:EVERGREEN ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GEORGLOE
Authorized Official - Last Name:ABOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-988-7140
Mailing Address - Street 1:14416 W 57TH PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1167
Mailing Address - Country:US
Mailing Address - Phone:303-432-2384
Mailing Address - Fax:303-954-0099
Practice Address - Street 1:7425 W HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5171
Practice Address - Country:US
Practice Address - Phone:303-988-7410
Practice Address - Fax:030-988-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC8896261QS0112X
CO8896261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT07527Medicare UPIN
CO802981Medicare ID - Type Unspecified