Provider Demographics
NPI:1952069205
Name:MINDFUL DENTISTRY
Entity Type:Organization
Organization Name:MINDFUL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-428-1201
Mailing Address - Street 1:1609 ZINNIA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9371
Mailing Address - Country:US
Mailing Address - Phone:410-428-1201
Mailing Address - Fax:
Practice Address - Street 1:3100 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1050
Practice Address - Country:US
Practice Address - Phone:303-499-0367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty