Provider Demographics
NPI:1740844588
Name:HAMPDEN DENTAL LOFT
Entity type:Organization
Organization Name:HAMPDEN DENTAL LOFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-930-8828
Mailing Address - Street 1:9250 E HAMPDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5413
Mailing Address - Country:US
Mailing Address - Phone:303-930-8828
Mailing Address - Fax:
Practice Address - Street 1:9250 E HAMPDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5413
Practice Address - Country:US
Practice Address - Phone:303-930-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty