Organization
PANORAMA DENTAL PROFESSIONAL LLC
Active
Other names
Panorama Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY WOHLGEMUTH (DENTIST)
(303) 755-8388
Entity
Organization
Contact information
Practice address
3095 S PARKER RD STE 150, AURORA, CO 80014-2917
(303) 755-8388
Mailing address
3095 S PARKER RD STE 150, AURORA, CO 80014-2917
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
104262
CO
1223G0001X
General Practice Dentistry
Primary
104262
CO
1223P0300X
Periodontics
104262
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
104262
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
104262
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104262
LICENSES
CO
Enumeration date
07/29/2015
Last updated
07/29/2015
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