Provider Demographics
NPI:1912306366
Name:ORNELAS, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 W 121ST AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5602
Mailing Address - Country:US
Mailing Address - Phone:303-469-2061
Mailing Address - Fax:303-362-5615
Practice Address - Street 1:4490 W 121ST AVE
Practice Address - Street 2:STE 7
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5602
Practice Address - Country:US
Practice Address - Phone:303-469-2061
Practice Address - Fax:303-362-5615
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR60476044122300000X
CODEN.00202622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist