NPIMap

Organization Active NPI

Village Park Dental PC

  • General Practice Dentistry
  • Aurora, CO
National Provider Identifier
1497928527
Registry record updated Apr 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9535 Issued in CO
Legal business name
VILLAGE PARK DENTAL PC
Practice address
11275 E Mississippi Ave
2 South 3
Aurora, CO 80012-3263
Phone
(303) 364-6455
Fax
(303) 364-6455
NPI assigned
Apr 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2008

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

Authorized official

Name
Dr. Rusty Kip Davis, DDS
Title
President
Phone
(303) 364-6455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9535 CO Primary

Addresses

Primary practice location

11275 E Mississippi Ave
2 South 3
Aurora, CO 80012-3263

Mailing address

11275 E Mississippi Ave
2 South 3
Aurora, CO 80012-3263
Phone (303) 364-6455

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207699200000",
    "number": "1497928527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11275 E MISSISSIPPI AVE",
            "address_2": "2 SOUTH 3",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800123263",
            "telephone_number": "303-364-6455",
            "fax_number": "303-364-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11275 E MISSISSIPPI AVE",
            "address_2": "2 SOUTH 3",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800123263",
            "telephone_number": "303-364-6455",
            "fax_number": "303-364-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PARK DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RUSTY",
        "authorized_official_middle_name": "KIP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-364-6455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.