Organization
COLORADO DHCA, 16TH STREET MALL, PLLC
Active
Other names
Dental Health at 16th Street Mall, PPLC
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE JUNIEL (MANAGER)
(303) 592-1133
Entity
Organization
Contact information
Practice address
1600 STOUT ST STE 600, DENVER, CO 80202-3106
(303) 592-1133
(303) 592-1265
Mailing address
1600 STOUT ST STE 600, DENVER, CO 80202-3106
(303) 592-1133
(303) 592-1265
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
579
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
841525799
SPECIALITY
CO
Enumeration date
02/20/2007
Last updated
07/09/2008
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