Provider Demographics
NPI:1447420922
Name:BLUESTEIN SURGICAL ARTS, PC
Entity Type:Organization
Organization Name:BLUESTEIN SURGICAL ARTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:303-938-1161
Mailing Address - Street 1:864 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2410
Mailing Address - Country:US
Mailing Address - Phone:303-938-1161
Mailing Address - Fax:
Practice Address - Street 1:864 W SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2410
Practice Address - Country:US
Practice Address - Phone:303-938-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39080261QS0112X
CO8312261QS0112X
OH30020765261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
488258Medicare PIN