Provider Demographics
NPI:1679337588
Name:ANCION, DAVE LEE-ROY (DDS)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:LEE-ROY
Last Name:ANCION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 E 56TH AVE APT 378
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4447
Mailing Address - Country:US
Mailing Address - Phone:786-752-5925
Mailing Address - Fax:
Practice Address - Street 1:15151 E 104TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8948
Practice Address - Country:US
Practice Address - Phone:303-287-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.00206135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program