Provider Demographics
NPI:1982370367
Name:DARAIS DENTAL
Entity Type:Organization
Organization Name:DARAIS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-422-5696
Mailing Address - Street 1:933 SELL AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4929
Mailing Address - Country:US
Mailing Address - Phone:719-422-5696
Mailing Address - Fax:
Practice Address - Street 1:933 SELL AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4929
Practice Address - Country:US
Practice Address - Phone:719-422-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARAIS DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty