Healthcare Provider Details

I. General information

NPI: 1821907502
Provider Name (Legal Business Name): OSMAN NASRELDIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CANYON BLVD STE 210
BOULDER CO
80302-6712
US

IV. Provider business mailing address

2700 CANYON BLVD STE 210
BOULDER CO
80302-6712
US

V. Phone/Fax

Practice location:
  • Phone: 720-924-2199
  • Fax:
Mailing address:
  • Phone: 720-924-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: