Provider Demographics
NPI:1811164833
Name:QUALDENT LLC
Entity type:Organization
Organization Name:QUALDENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-934-1122
Mailing Address - Street 1:26 ROYAL ANN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1408
Mailing Address - Country:US
Mailing Address - Phone:720-934-1122
Mailing Address - Fax:
Practice Address - Street 1:26 ROYAL ANN DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1408
Practice Address - Country:US
Practice Address - Phone:720-934-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty