Provider Demographics
NPI:1689797086
Name:DONALD A DECINO, D.D.S., P,C,
Entity Type:Organization
Organization Name:DONALD A DECINO, D.D.S., P,C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:DECINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-996-8500
Mailing Address - Street 1:3405 S YARROW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4965
Mailing Address - Country:US
Mailing Address - Phone:303-996-8500
Mailing Address - Fax:303-996-8501
Practice Address - Street 1:3405 S YARROW ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4965
Practice Address - Country:US
Practice Address - Phone:303-996-8500
Practice Address - Fax:303-996-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61445Medicare ID - Type Unspecified