Provider Demographics
NPI:1689108961
Name:SPECTRUM DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:SPECTRUM DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-388-5599
Mailing Address - Street 1:6660 E HAMPDEN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3033
Mailing Address - Country:US
Mailing Address - Phone:303-368-0777
Mailing Address - Fax:
Practice Address - Street 1:6660 E HAMPDEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-3035
Practice Address - Country:US
Practice Address - Phone:303-388-5599
Practice Address - Fax:303-388-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherEIN