Provider Demographics
NPI:1568748218
Name:ULIBARRI, JOSHUA R (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
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 1:4214 CENTERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3716
Mailing Address - Country:US
Mailing Address - Phone:970-475-6601
Mailing Address - Fax:
Practice Address - Street 1:4214 CENTERPLACE DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3716
Practice Address - Country:US
Practice Address - Phone:970-475-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12971122300000X
CODEN.00203852122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid