Provider Demographics
NPI:1659503860
Name:HAVANA AND COLFAX DENTAL PARTNERS PROFF LLP
Entity Type:Organization
Organization Name:HAVANA AND COLFAX DENTAL PARTNERS PROFF LLP
Other - Org Name:COMFORT DENTAL COLFAX/HAVANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-344-2283
Mailing Address - Street 1:10401 E. COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010
Mailing Address - Country:US
Mailing Address - Phone:303-344-2273
Mailing Address - Fax:303-344-2286
Practice Address - Street 1:10401 E. COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010
Practice Address - Country:US
Practice Address - Phone:303-344-2273
Practice Address - Fax:303-344-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79771223G0001X
CO91281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty