Provider Demographics
NPI:1497098974
Name:IRARRAZABAL, ANDREA (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:IRARRAZABAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1457
Mailing Address - Country:US
Mailing Address - Phone:954-610-0117
Mailing Address - Fax:
Practice Address - Street 1:3216 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1043
Practice Address - Country:US
Practice Address - Phone:303-442-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0596711223G0001X
CO002043031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice