Provider Demographics
NPI:1710591342
Name:STATION DENTAL GROUP, PC
Entity Type:Organization
Organization Name:STATION DENTAL GROUP, PC
Other - Org Name:STATION DENTAL HIGHLANDS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-519-9995
Mailing Address - Street 1:14001 E ILIFF AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1427
Mailing Address - Country:US
Mailing Address - Phone:303-337-0047
Mailing Address - Fax:
Practice Address - Street 1:14001 E ILIFF AVE STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1424
Practice Address - Country:US
Practice Address - Phone:303-425-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATION DENTAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty