# DR. TIMOTHY J. WACHUTA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629457635
- **Authorized official:** DR. TIMOTHY JOHN WACHUTA DDS (DENTIST/OWNER)
- **Authorized official phone:** (303) 638-9440

## Contact information

- **Practice address:** 2709 S. COLORADO BLVD., DENVER, CO 80222
- **Practice address phone:** (303) 756-2770
- **Practice address fax:** (303) 758-5705
- **Mailing address:** 2709 S COLORADO BLVD, DENVER, CO 80222-6601
- **Mailing address phone:** (303) 756-2770
- **Mailing address fax:** (303) 758-5705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 7007 | CO | — |
| 302R00000X | Health Maintenance Organization | 7007 | CO | Yes |

## Other

- **Enumeration date:** 05/22/2015
- **Last updated:** 05/22/2015