Provider Demographics
NPI:1629282850
Name:ADVANCED ORTHODONTICS
Entity Type:Organization
Organization Name:ADVANCED ORTHODONTICS
Other - Org Name:DR. KIRK J. NIELSON D.D.S., M.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-690-0400
Mailing Address - Street 1:16756 E SMOKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2470
Mailing Address - Country:US
Mailing Address - Phone:303-248-7200
Mailing Address - Fax:303-680-1157
Practice Address - Street 1:16756 E SMOKY HILL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2470
Practice Address - Country:US
Practice Address - Phone:303-248-7200
Practice Address - Fax:303-680-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty