Provider Demographics
NPI:1457716938
Name:ADVANCED DENTAL SOLUTIONS PC
Entity Type:Organization
Organization Name:ADVANCED DENTAL SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ZUNDEL
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-507-6959
Mailing Address - Street 1:500 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-3502
Mailing Address - Country:US
Mailing Address - Phone:303-507-6959
Mailing Address - Fax:970-675-3355
Practice Address - Street 1:500 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-3502
Practice Address - Country:US
Practice Address - Phone:303-507-6959
Practice Address - Fax:970-675-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71789065Medicaid