Provider Demographics
NPI:1881026854
Name:AURORA DENTAL GROUP LLC
Entity Type:Organization
Organization Name:AURORA DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-217-5794
Mailing Address - Street 1:724 PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8231
Mailing Address - Country:US
Mailing Address - Phone:303-745-2052
Mailing Address - Fax:303-745-2189
Practice Address - Street 1:724 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8231
Practice Address - Country:US
Practice Address - Phone:303-745-2052
Practice Address - Fax:303-745-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8412305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1477665164Medicaid