Provider Demographics
NPI:1831114347
Name:ALPHA DENTAL CARE IX PC
Entity Type:Organization
Organization Name:ALPHA DENTAL CARE IX PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-447-2281
Mailing Address - Street 1:1900 FOLSOM ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302
Mailing Address - Country:US
Mailing Address - Phone:303-447-2281
Mailing Address - Fax:303-447-2285
Practice Address - Street 1:1900 FOLSOM ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302
Practice Address - Country:US
Practice Address - Phone:303-447-2281
Practice Address - Fax:303-447-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty