Provider Demographics
NPI:1598981490
Name:REGENTS OF THE UNIVERSITY OF COLORADO
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF COLORADO
Other - Org Name:UNIVERSITY OF COLORADO DEPARTMENT OF ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:N
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-724-7001
Mailing Address - Street 1:13065 E 17TH PL
Mailing Address - Street 2:MAIL STOP F846
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7238
Mailing Address - Country:US
Mailing Address - Phone:303-724-7001
Mailing Address - Fax:
Practice Address - Street 1:13065 E 17TH PL
Practice Address - Street 2:MAIL STOP F846
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7238
Practice Address - Country:US
Practice Address - Phone:303-724-7001
Practice Address - Fax:
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
CO71001223X0400X
CO1048781223X0400X
CO90231223X0400X
CO1049281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40224520Medicaid