Organization
DENVER HEALTH AND HOSPITAL AUTHORITY
Active
Other names
I D Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY J BURNETTE (CHIEF FINANCIAL OFFICER)
(303) 602-4964
Entity
Organization
Contact information
Practice address
777 BANNOCK ST, MC 1923, DENVER, CO 80204-4507
(303) 436-6000
Mailing address
777 BANNOCK ST, MC 1923, DENVER, CO 80204-4507
(303) 436-6000
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
010444
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04019220
—
CO
Enumeration date
08/27/2007
Last updated
12/28/2015
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