Provider Demographics
NPI:1730670373
Name:UYEMURA CHOICE DENTISTRY LLC
Entity Type:Organization
Organization Name:UYEMURA CHOICE DENTISTRY LLC
Other - Org Name:MARK D. UYEMURA, DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:UYEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-352-7600
Mailing Address - Street 1:4689 W 20TH ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3218
Mailing Address - Country:US
Mailing Address - Phone:970-352-7600
Mailing Address - Fax:
Practice Address - Street 1:4689 W 20TH ST UNIT D
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3218
Practice Address - Country:US
Practice Address - Phone:970-352-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7975261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental