Basic Information
| Provider Information | |||||||||
| NPI: | 1578766010 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDRE D. NAZAROV DMD.,MS.,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11211 S DRANSFELDT RD | ||||||||
| Address2: | 122 | ||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801349385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208424544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11211 S DRANSFELDT RD | ||||||||
| Address2: | 122 | ||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801349385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208424544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NAZAROV | ||||||||
| AuthorizedOfficialFirstName: | ANDRE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7208424544 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DMD.,MS.,PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 8530 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.