Provider Demographics
NPI:1790141539
Name:INTEGRITY DENTAL OF BOULDER, LTD
Entity Type:Organization
Organization Name:INTEGRITY DENTAL OF BOULDER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORBETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:303-442-6141
Mailing Address - Street 1:305 IRWIN PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6554
Mailing Address - Country:US
Mailing Address - Phone:303-442-6141
Mailing Address - Fax:303-545-5669
Practice Address - Street 1:777 29TH ST
Practice Address - Street 2:STE. #300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2358
Practice Address - Country:US
Practice Address - Phone:303-442-6141
Practice Address - Fax:303-545-5669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5129261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental