Provider Demographics
NPI:1902024425
Name:MILE HIGH DENTAL CENTERS
Entity Type:Organization
Organization Name:MILE HIGH DENTAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-799-1715
Mailing Address - Street 1:8456 N HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9119
Mailing Address - Country:US
Mailing Address - Phone:303-799-1715
Mailing Address - Fax:303-799-1717
Practice Address - Street 1:1727 GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1205
Practice Address - Country:US
Practice Address - Phone:303-388-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty