Provider Demographics
NPI:1558360859
Name:BOLLENBAUGH, KEITH DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DEAN
Last Name:BOLLENBAUGH
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 1:2201 W WILDCAT RESERVE PKWY
Mailing Address - Street 2:UNIT C-6
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5490
Mailing Address - Country:US
Mailing Address - Phone:303-220-1122
Mailing Address - Fax:303-220-1044
Practice Address - Street 1:2201 W WILDCAT RESERVE PKWY
Practice Address - Street 2:UNIT C-6
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5490
Practice Address - Country:US
Practice Address - Phone:303-220-1122
Practice Address - Fax:303-220-1044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice