Provider Demographics
NPI:1629694724
Name:DOWNTOWN DENVER DENTAL PLLC
Entity Type:Organization
Organization Name:DOWNTOWN DENVER DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-296-1825
Mailing Address - Street 1:1050 17TH ST STE B-190
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80265-1050
Mailing Address - Country:US
Mailing Address - Phone:303-296-1825
Mailing Address - Fax:303-296-2107
Practice Address - Street 1:1050 17TH ST STE B-190
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80265-1050
Practice Address - Country:US
Practice Address - Phone:303-296-1825
Practice Address - Fax:303-296-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental