Arace Nana Assadoghli, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN00204743 Issued in CO

Practice address

4490 W 121St Ave Ste 7
Broomfield, CO 80020-5603

Phone

(303) 469-2061

Fax

(303) 275-8011

NPI assigned

Aug 29, 2018

Last updated

Oct 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1043792815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32527 LITTLE CUB RD",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804396657",
            "telephone_number": "904-710-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4490 W 121ST AVE STE 7",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800205603",
            "telephone_number": "303-469-2061",
            "fax_number": "303-275-8011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11806 Atlantic Blvd Ste 4",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322252968",
            "country_code": "US",
            "telephone_number": "904-717-0679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14255 W Colfax Ave Ste E",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "804013264",
            "country_code": "US",
            "telephone_number": "315-454-6000",
            "fax_number": "866-803-4943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ASSADOGHLI",
        "first_name": "ARACE",
        "middle_name": "NANA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN23786",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN00204743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.