Provider Demographics
NPI:1952847485
Name:AURARIA DENTAL OASIS
Entity Type:Organization
Organization Name:AURARIA DENTAL OASIS
Other - Org Name:AURARIA DENTAL CENTRE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-573-5533
Mailing Address - Street 1:1050 W COLFAX AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2072
Mailing Address - Country:US
Mailing Address - Phone:303-573-5533
Mailing Address - Fax:303-573-5539
Practice Address - Street 1:1050 W COLFAX AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2072
Practice Address - Country:US
Practice Address - Phone:303-573-5533
Practice Address - Fax:303-573-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00104752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty