Provider Demographics
NPI:1740310788
Name:BOULDER ENDODONTICS PC
Entity type:Organization
Organization Name:BOULDER ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-449-6621
Mailing Address - Street 1:3100 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1093
Mailing Address - Country:US
Mailing Address - Phone:303-449-6621
Mailing Address - Fax:303-413-9341
Practice Address - Street 1:3100 ARAPAHOE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1093
Practice Address - Country:US
Practice Address - Phone:303-449-6621
Practice Address - Fax:303-413-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1033117239OtherG. BRUCE DOUGLAS, D.D.S.
CO1740310788OtherBOULDER ENDODONTICS, PC
CO1487652582OtherJOSEPH R. PARSONS, D.D.S.