Provider Demographics
NPI:1659886653
Name:AFFINITY DENTAL ARTS, PLLC
Entity Type:Organization
Organization Name:AFFINITY DENTAL ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-829-0591
Mailing Address - Street 1:601 E HAMPDEN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2769
Mailing Address - Country:US
Mailing Address - Phone:303-788-6462
Mailing Address - Fax:303-781-9763
Practice Address - Street 1:601 E HAMPDEN AVE STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2769
Practice Address - Country:US
Practice Address - Phone:303-788-6462
Practice Address - Fax:303-781-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental