Provider Demographics
NPI:1578975207
Name:AA EMERGENCY DENTAL
Entity Type:Organization
Organization Name:AA EMERGENCY DENTAL
Other - Org Name:EMERGENCY DENTAL CARE USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-503-3184
Mailing Address - Street 1:916 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3124
Mailing Address - Country:US
Mailing Address - Phone:303-503-3184
Mailing Address - Fax:866-839-8849
Practice Address - Street 1:7500 E ARAPAHOE RD STE 202
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1277
Practice Address - Country:US
Practice Address - Phone:303-495-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental