Provider Demographics
NPI:1497818256
Name:MOHELICKI, ANIA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANIA
Middle Name:MARIA
Last Name:MOHELICKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 28TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1096
Mailing Address - Country:US
Mailing Address - Phone:303-443-0998
Mailing Address - Fax:303-544-0372
Practice Address - Street 1:1400 28TH ST
Practice Address - Street 2:STE 4
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1096
Practice Address - Country:US
Practice Address - Phone:303-443-0998
Practice Address - Fax:303-544-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice