Provider Demographics
NPI:1972647303
Name:CODY DENTAL GROUP
Entity Type:Organization
Organization Name:CODY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESSELY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:303-758-5858
Mailing Address - Street 1:4301 E AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6790
Mailing Address - Country:US
Mailing Address - Phone:303-758-5858
Mailing Address - Fax:303-758-6753
Practice Address - Street 1:4301 E AMHERST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6790
Practice Address - Country:US
Practice Address - Phone:303-758-5858
Practice Address - Fax:303-758-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
CO35141223G0001X
CO37671223G0001X
CO4861223G0001X
CO5461223G0001X
CO79961223G0001X
CO83591223G0001X
CO4871223G0001X
CO67731223G0001X
CO70771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty