Provider Demographics
NPI:1760969059
Name:BOULDER ENDODONTICS PLLC
Entity Type:Organization
Organization Name:BOULDER ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-449-6621
Mailing Address - Street 1:2575 PEARL ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3851
Mailing Address - Country:US
Mailing Address - Phone:303-449-6621
Mailing Address - Fax:
Practice Address - Street 1:2575 PEARL ST STE 1C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3851
Practice Address - Country:US
Practice Address - Phone:303-449-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 261QD0000X
CODEN00202320261QD0000X
CODEN.00010258261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental