Organization
ADVANCED DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON RONALD VAN WAGENEN (PARTNER)
(303) 426-4860
Entity
Organization
Contact information
Practice address
1557 W 84TH AVE UNIT 1, FEDERAL HEIGHTS, CO 80260-4780
(303) 426-4860
(303) 426-1530
Mailing address
1557 W 84TH AVE UNIT 1, FEDERAL HEIGHTS, CO 80260-4780
(303) 426-4860
(303) 426-1530
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8478
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
98681753
—
CO
Enumeration date
07/09/2014
Last updated
09/16/2015
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