Provider Demographics
NPI:1558461764
Name:WURTZEBACH, ROBERT JOHN (DDS, RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:WURTZEBACH
Suffix:
Gender:M
Credentials:DDS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 W HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5171
Mailing Address - Country:US
Mailing Address - Phone:303-969-8989
Mailing Address - Fax:303-969-8994
Practice Address - Street 1:7425 W HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5171
Practice Address - Country:US
Practice Address - Phone:303-969-8989
Practice Address - Fax:303-969-8994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4631223G0001X
CO15445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No183500000XPharmacy Service ProvidersPharmacist