Provider Demographics
NPI:1477761062
Name:NEDBALSKI, TERRENCE R (DDS)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:R
Last Name:NEDBALSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3450 PENROSE PL
Mailing Address - Street 2:STE# 120
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1828
Mailing Address - Country:US
Mailing Address - Phone:303-447-9735
Mailing Address - Fax:303-447-1025
Practice Address - Street 1:3450 PENROSE PL
Practice Address - Street 2:STE #120
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1828
Practice Address - Country:US
Practice Address - Phone:303-447-9735
Practice Address - Fax:303-447-1025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO94101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery