Provider Demographics
NPI:1922063460
Name:TOMASETTI, BOYD JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:JEFFREY
Last Name:TOMASETTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 TIMBER FALLS CT UNIT 1507
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4877
Mailing Address - Country:US
Mailing Address - Phone:720-289-0574
Mailing Address - Fax:
Practice Address - Street 1:4480 TIMBER FALLS CT UNIT 1507
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4877
Practice Address - Country:US
Practice Address - Phone:720-289-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60252Medicare UPIN
COB1815Medicare PIN