CMS-1500 Box 24J / 33a • NPI
1609390632
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
1223G0001X (CMS C5)
Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)
Box 32 Service Location & ZIP+4
3550 W 38TH AVE., #5, DENVER, CO, 80211
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1609390632 (38TH MODERN DENTAL PRACTICE, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1609390632 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 38TH MODERN DENTAL PRACTICE, LLC |
| Plain-English Specialty | Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: 1223G0001X (Dentist, General Practice) |
| Certifying / Licensing Body | American Dental Association (ADA) / State Board of Dental Examiners |
| Practice Location Address | 3550 W 38TH AVE., #5, DENVER, CO, 80211 |
| Practice Telephone / Fax | Tel: (303) 515-7008 | Fax: (888) 790-7062 |
| Administrative Mailing Address | 6020 N CAREFREE CIR, COLORADO SPRINGS, CO, 80922-2402 |
| Enumeration & Last Sync | Enumerated: 2017-08-01 | CMS Record Updated: 2017-08-01 |
| Authorized Official | SCOTT FREDERICK (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (1223G0001X)
What Does Taxonomy Code 1223G0001X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223G0001X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (38TH MODERN DENTAL PRACTICE, LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
- Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions
- Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
- Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
122300000X — DentistPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Secondary |
1223P0300X — Dentist, PeriodonticsPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Secondary |
1223S0112X — Dentist, Oral and Maxillofacial SurgeryPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Secondary |
1223G0001X — Dentist, General PracticePlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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