Provider Demographics
NPI:1760995476
Name:SOUTHEAST DENTAL ARTS,LLC
Entity Type:Organization
Organization Name:SOUTHEAST DENTAL ARTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-741-1011
Mailing Address - Street 1:4380 S SYRACUSE ST STE 504
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2628
Mailing Address - Country:US
Mailing Address - Phone:303-741-1011
Mailing Address - Fax:303-741-1189
Practice Address - Street 1:4380 S SYRACUSE ST STE 504
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2628
Practice Address - Country:US
Practice Address - Phone:303-741-1011
Practice Address - Fax:303-741-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6988261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental