Provider Demographics
NPI:1801208905
Name:KIRK R. RATHBURN D.D.S.
Entity Type:Organization
Organization Name:KIRK R. RATHBURN D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:RATHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-786-9673
Mailing Address - Street 1:2709 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2433
Mailing Address - Country:US
Mailing Address - Phone:303-786-9673
Mailing Address - Fax:303-545-6788
Practice Address - Street 1:2709 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2433
Practice Address - Country:US
Practice Address - Phone:303-786-9673
Practice Address - Fax:303-545-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty