Organization
SOUTH FEDERAL DENTAL GP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE L FARMER (PRESIDENT)
(303) 934-0232
Entity
Organization
Contact information
Practice address
1601 SO FEDERAL BLVD, SUITE 201, DENVER, CO 80219
(303) 934-0232
(303) 934-2208
Mailing address
1601 SO FEDERAL BLVD, SUITE 201, DENVER, CO 80219
(303) 934-0232
(303) 934-2208
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105415
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04001301
—
CO
Enumeration date
12/15/2006
Last updated
08/22/2020
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