Provider Demographics
NPI:1356377956
Name:AURORA DENTAL PARTNERS PROF LLP
Entity type:Organization
Organization Name:AURORA DENTAL PARTNERS PROF LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAEGON
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-367-2273
Mailing Address - Street 1:1050 S. PEORIA ST.
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012
Mailing Address - Country:US
Mailing Address - Phone:303-367-2273
Mailing Address - Fax:303-367-5385
Practice Address - Street 1:1050 SOUTH PEORIA STREET
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-367-2273
Practice Address - Fax:303-367-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011979Medicaid