Provider Demographics
NPI:1770755381
Name:KIDS CHOICE DENTAL OF AURORA PC
Entity type:Organization
Organization Name:KIDS CHOICE DENTAL OF AURORA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSHADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-341-5437
Mailing Address - Street 1:15159 E COLFAX AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-5707
Mailing Address - Country:US
Mailing Address - Phone:303-341-5437
Mailing Address - Fax:303-341-5447
Practice Address - Street 1:15159 E COLFAX AVE UNIT B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5707
Practice Address - Country:US
Practice Address - Phone:303-341-5437
Practice Address - Fax:303-341-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44034067Medicaid