Provider Demographics
NPI:1790761690
Name:AHN, HENRY D (DMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:D
Last Name:AHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 S BAHAMA CIR
Mailing Address - Street 2:UNIT A
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6503
Mailing Address - Country:US
Mailing Address - Phone:661-578-8169
Mailing Address - Fax:
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 2N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3263
Practice Address - Country:US
Practice Address - Phone:303-750-3737
Practice Address - Fax:303-751-2285
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358751223G0001X
CO97181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice