Provider Demographics
NPI:1922200542
Name:ANDRE D. NAZAROV DMD.,MS.,PC
Entity Type:Organization
Organization Name:ANDRE D. NAZAROV DMD.,MS.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS,PC
Authorized Official - Phone:303-989-5607
Mailing Address - Street 1:7125 W JEFFERSON AVE
Mailing Address - Street 2:380
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2333
Mailing Address - Country:US
Mailing Address - Phone:303-989-5607
Mailing Address - Fax:
Practice Address - Street 1:7125 W JEFFERSON AVE
Practice Address - Street 2:380
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2333
Practice Address - Country:US
Practice Address - Phone:303-989-5607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty