Healthcare Provider Details

I. General information

NPI: 1386563781
Provider Name (Legal Business Name): EVELYN QI DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5387 MANHATTAN CIR STE 102
BOULDER CO
80303-4283
US

IV. Provider business mailing address

5387 MANHATTAN CIR STE 102
BOULDER CO
80303-4283
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-0558
  • Fax:
Mailing address:
  • Phone: 303-499-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVELYN QI
Title or Position: DENTIST
Credential: DMD
Phone: 813-503-7569