Provider Demographics
NPI:1780924613
Name:QUINCY & BUCKLEY DENTAL GROUP PROFESSIONAL LLC
Entity type:Organization
Organization Name:QUINCY & BUCKLEY DENTAL GROUP PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-617-8400
Mailing Address - Street 1:16981 E QUINCY AVE
Mailing Address - Street 2:#D1-D3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2769
Mailing Address - Country:US
Mailing Address - Phone:303-617-8400
Mailing Address - Fax:303-617-3516
Practice Address - Street 1:16981 E QUINCY AVE
Practice Address - Street 2:#D1-D3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2769
Practice Address - Country:US
Practice Address - Phone:303-617-8400
Practice Address - Fax:303-617-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72601223G0001X
CO98031223G0001X
CO101291223G0001X
CO85721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty