Provider Demographics
NPI:1407065733
Name:JAY E SWARTZWELTER D.D.S.
Entity Type:Organization
Organization Name:JAY E SWARTZWELTER D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:SWARTZWELTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-417-1644
Mailing Address - Street 1:1200 28TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1756
Mailing Address - Country:US
Mailing Address - Phone:303-417-1644
Mailing Address - Fax:303-417-1790
Practice Address - Street 1:1200 28TH ST STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1756
Practice Address - Country:US
Practice Address - Phone:303-417-1644
Practice Address - Fax:303-417-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty