Provider Demographics
NPI:1891423208
Name:BOULDER SMILES
Entity Type:Organization
Organization Name:BOULDER SMILES
Other - Org Name:BOULDER SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-546-3575
Mailing Address - Street 1:1636 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6356
Mailing Address - Country:US
Mailing Address - Phone:720-546-3575
Mailing Address - Fax:
Practice Address - Street 1:1636 16TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6356
Practice Address - Country:US
Practice Address - Phone:303-443-4417
Practice Address - Fax:303-443-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental