NPIMap

Organization Active NPI

Aj Canon Dental

  • Dental Clinic/Center
  • Canon City, CO
National Provider Identifier
1639561467
Registry record updated Mar 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
10543 Issued in CO
Legal business name
AJ CANON DENTAL
Practice address
1227 S 9TH St
Canon City, CO 81212-4211
Phone
(719) 285-4784
Fax
(719) 345-4120
NPI assigned
Mar 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2015

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

Authorized official

Name
Dr. Allen Jesse Lee, DMD
Title
Owner
Phone
(650) 722-0005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 10543 CO Primary

Addresses

Primary practice location

1227 S 9TH St
Canon City, CO 81212-4211

Mailing address

1227 S 9TH St
Canon City, CO 81212-4211
Phone (719) 285-4784

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1639561467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 S 9TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124211",
            "telephone_number": "719-285-4784",
            "fax_number": "719-345-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 S 9TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124211",
            "telephone_number": "719-285-4784",
            "fax_number": "719-345-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AJ CANON DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-03",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-722-0005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CO",
            "license": "10543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.