Provider Demographics
NPI:1700388592
Name:DENTAL MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:DENTAL MANAGEMENT GROUP LLC
Other - Org Name:ORAL SURGERY CENTER - MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-344-0810
Mailing Address - Street 1:11246 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3202
Mailing Address - Country:US
Mailing Address - Phone:303-344-0810
Mailing Address - Fax:
Practice Address - Street 1:11246 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3202
Practice Address - Country:US
Practice Address - Phone:303-344-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL MANAGEMENT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02066165Medicaid