Provider Demographics
NPI:1134447857
Name:BOULDER DENTAL CENTER, P.C
Entity type:Organization
Organization Name:BOULDER DENTAL CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-5000
Mailing Address - Street 1:1610 CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5407
Mailing Address - Country:US
Mailing Address - Phone:303-442-5000
Mailing Address - Fax:303-442-4396
Practice Address - Street 1:1610 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5407
Practice Address - Country:US
Practice Address - Phone:303-442-5000
Practice Address - Fax:303-442-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty