Provider Demographics
NPI:1023589181
Name:BASALT DENTISTRY, PC
Entity type:Organization
Organization Name:BASALT DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAERTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-376-4769
Mailing Address - Street 1:227 MIDLAND AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8119
Mailing Address - Country:US
Mailing Address - Phone:970-927-5437
Mailing Address - Fax:
Practice Address - Street 1:227 MIDLAND AVE STE C3
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8119
Practice Address - Country:US
Practice Address - Phone:970-927-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental