Provider Demographics
NPI:1801962410
Name:BETHERS, JOHN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BETHERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 ALEXANDER WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-8028
Mailing Address - Country:US
Mailing Address - Phone:909-254-1764
Mailing Address - Fax:
Practice Address - Street 1:2525 28TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1256
Practice Address - Country:US
Practice Address - Phone:303-443-0070
Practice Address - Fax:303-443-0073
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice