Provider Demographics
NPI:1740552371
Name:MILE HIGH DENTISTRY
Entity type:Organization
Organization Name:MILE HIGH DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-364-7631
Mailing Address - Street 1:11275 E MISSISSIPPI AVE
Mailing Address - Street 2:#2W1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3263
Mailing Address - Country:US
Mailing Address - Phone:303-364-7631
Mailing Address - Fax:
Practice Address - Street 1:11275 E MISSISSIPPI AVE
Practice Address - Street 2:#2W1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3263
Practice Address - Country:US
Practice Address - Phone:303-364-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty