Provider Demographics
NPI:1619452489
Name:OPEN AND AFFORDABLE DENTAL CHERRY CREEK PLLC
Entity Type:Organization
Organization Name:OPEN AND AFFORDABLE DENTAL CHERRY CREEK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAKTINSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-355-8670
Mailing Address - Street 1:12357 E CORNELL AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3323
Mailing Address - Country:US
Mailing Address - Phone:303-337-5800
Mailing Address - Fax:
Practice Address - Street 1:3773 CHERRY CREEK DR
Practice Address - Street 2:UNIT 120
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209
Practice Address - Country:US
Practice Address - Phone:303-355-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty