Provider Demographics
NPI:1770582066
Name:BOTTONE, PAUL W
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:BOTTONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 E BELLEVIEW AVE
Mailing Address - Street 2:#101
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1618
Mailing Address - Country:US
Mailing Address - Phone:303-741-2717
Mailing Address - Fax:303-741-2718
Practice Address - Street 1:6950 E BELLEVIEW AVE
Practice Address - Street 2:#101
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1618
Practice Address - Country:US
Practice Address - Phone:303-741-2717
Practice Address - Fax:303-741-2718
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0200-3317Medicaid