Provider Demographics
NPI:1750475927
Name:CRANIOFACIAL DIAGNOSTIC CENTER, PC C/O STEPHEN WINBER, PRESIDENT
Entity Type:Organization
Organization Name:CRANIOFACIAL DIAGNOSTIC CENTER, PC C/O STEPHEN WINBER, PRESIDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:WINBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPS
Authorized Official - Phone:303-691-0267
Mailing Address - Street 1:1660 S ALBION ST
Mailing Address - Street 2:1008
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4008
Mailing Address - Country:US
Mailing Address - Phone:303-691-0267
Mailing Address - Fax:303-691-0268
Practice Address - Street 1:1660 S ALBION ST
Practice Address - Street 2:1008
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4008
Practice Address - Country:US
Practice Address - Phone:303-691-0267
Practice Address - Fax:303-691-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48936375Medicaid