Organization
BLUE MESA DENTISTRY AT SOUTHGLENN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA ANNE NICHOLSON (OFFICE MANAGER)
(303) 703-4544
Entity
Organization
Contact information
Practice address
2001 E EASTER AVE, #200, CENTENNIAL, CO 80122
(303) 703-4544
(303) 703-3610
Mailing address
2001 E EASTER AVE, #200, CENTENNIAL, CO 80122
(303) 703-4544
(303) 703-3610
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6372
CO
122300000X
Dentist
6619
CO
Other
Enumeration date
01/19/2007
Last updated
08/22/2020
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