Healthcare Provider Details

I. General information

NPI: 1023838430
Provider Name (Legal Business Name): S. MATT SCHACHT, D.D.S., PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 28TH ST STE 200
BOULDER CO
80301-1263
US

IV. Provider business mailing address

130 RAMPART WAY STE 100
DENVER CO
80230-6443
US

V. Phone/Fax

Practice location:
  • Phone: 303-341-7151
  • Fax:
Mailing address:
  • Phone: 303-341-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN MATTHEW SCHACHT
Title or Position: PRESIDENT
Credential: DDS
Phone: 303-341-7151