Provider Demographics
NPI:1477854396
Name:ULIBARRI, RYAN LEVI (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEVI
Last Name:ULIBARRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 BOARDWALK DR UNIT C2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3769
Mailing Address - Country:US
Mailing Address - Phone:970-224-5599
Mailing Address - Fax:970-224-5599
Practice Address - Street 1:4745 E BOARDWALK DR UNIT C2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3769
Practice Address - Country:US
Practice Address - Phone:970-224-5599
Practice Address - Fax:970-224-0731
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00202189122300000X
CODEN.00202189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist