Provider Demographics
NPI:1619113990
Name:UTBERG FAMILY DENTISTRY
Entity Type:Organization
Organization Name:UTBERG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:UTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-841-5313
Mailing Address - Street 1:17167 EAST CEDAR GULCH PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:303-841-5313
Mailing Address - Fax:303-841-5557
Practice Address - Street 1:17167 E. CEDAR GULCH PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-841-5313
Practice Address - Fax:303-841-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104866122300000X
CO6956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty