Healthcare Provider Details

I. General information

NPI: 1619726965
Provider Name (Legal Business Name): BOULDER DENTISTRY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 ARAPAHOE AVE STE 200
BOULDER CO
80303-1032
US

IV. Provider business mailing address

4141 ARAPAHOE AVE STE 200
BOULDER CO
80303-1032
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-8165
  • Fax:
Mailing address:
  • Phone: 303-718-7270
  • 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: MRS. JENNIFER BRITT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 303-718-7270