Provider Demographics
NPI:1770689275
Name:AXIOM DENTAL GROUP P.C.
Entity Type:Organization
Organization Name:AXIOM DENTAL GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-695-0102
Mailing Address - Street 1:12510 E ILIFF AVE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6376
Mailing Address - Country:US
Mailing Address - Phone:303-695-0102
Mailing Address - Fax:303-695-0714
Practice Address - Street 1:12510 E ILIFF AVE
Practice Address - Street 2:SUITE #305
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6376
Practice Address - Country:US
Practice Address - Phone:303-695-0102
Practice Address - Fax:303-695-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty