Provider Demographics
NPI:1619304268
Name:BERWEEN MOURADY DDS PLLC
Entity Type:Organization
Organization Name:BERWEEN MOURADY DDS PLLC
Other - Org Name:KIDS FIRST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-763-9020
Mailing Address - Street 1:9362 S COLORADO BLVD UNIT D14
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5207
Mailing Address - Country:US
Mailing Address - Phone:651-431-8148
Mailing Address - Fax:
Practice Address - Street 1:9362 S COLORADO BLVD UNIT D14
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5207
Practice Address - Country:US
Practice Address - Phone:651-431-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COD10279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty