NPIMap

Organization Active NPI

Dental Management Group LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Thornton, CO
National Provider Identifier
1679905665
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
6616 Issued in CO
Legal business name
DENTAL MANAGEMENT GROUP LLC
Practice address
2220 East 104TH Avenue
Suite 116
Thornton, CO 80233
Phone
(303) 344-0810
NPI assigned
Aug 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Authorized official

Name
Ashraf Sedhom, M.D.
Title
President
Phone
(303) 344-0810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 6616 CO Primary

Addresses

Primary practice location

2220 East 104TH Avenue
Suite 116
Thornton, CO 80233

Mailing address

2220 East 104TH Avenue
Suite 116
Thornton, CO 80233

Other identifiers 1

IdentifierTypeStateIssuer
02066165MedicaidCO

Other names 1

  • Oral Surgery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Management Group LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683590400000",
    "number": "1679905665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2220 EAST 104TH AVENUE",
            "address_2": "SUITE 116",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "80233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 EAST 104TH AVENUE",
            "address_2": "SUITE 116",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "80233",
            "telephone_number": "303-344-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-01",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A",
        "authorized_official_last_name": "SEDHOM",
        "authorized_official_first_name": "ASHRAF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-344-0810",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "6616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02066165",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oral Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; 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.