Provider Demographics
NPI:1356737845
Name:RETRO DENTAL GROUP AURORA
Entity type:Organization
Organization Name:RETRO DENTAL GROUP AURORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-681-7700
Mailing Address - Street 1:2993 S. PEORIA STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:818-681-7700
Mailing Address - Fax:
Practice Address - Street 1:2993 S PEORIA ST STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5707
Practice Address - Country:US
Practice Address - Phone:818-681-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETRO DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty