Healthcare Provider Details

I. General information

NPI: 1760969059
Provider Name (Legal Business Name): BOULDER ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 PEARL ST STE 1C
BOULDER CO
80302-3851
US

IV. Provider business mailing address

2575 PEARL ST STE 1C
BOULDER CO
80302-3851
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-6621
  • Fax:
Mailing address:
  • Phone: 303-449-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN00202320
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDEN.00010258
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS DAVID SCHULTE
Title or Position: ENDODONTIST
Credential: DDS
Phone: 303-449-6621