Organization
DENTAL MANAGEMENT GROUP LLC
Active
Other names
Oral Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
ASHRAF SEDHOM M.D. (PRESIDENT)
(303) 344-0810
Entity
Organization
Contact information
Practice address
2220 EAST 104TH AVENUE, SUITE 116, THORNTON, CO 80233
(303) 344-0810
Mailing address
2220 EAST 104TH AVENUE, SUITE 116, THORNTON, CO 80233
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6616
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02066165
—
CO
Enumeration date
08/01/2013
Last updated
05/09/2023
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