Healthcare Provider Details

I. General information

NPI: 1033468269
Provider Name (Legal Business Name): JEFFREY LOBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 E GIRARD AVE STE A205
DENVER CO
80231-5503
US

IV. Provider business mailing address

10200 E GIRARD AVE STE A205
DENVER CO
80231-5503
US

V. Phone/Fax

Practice location:
  • Phone: 303-745-9200
  • Fax: 303-752-3645
Mailing address:
  • Phone: 303-745-9200
  • Fax: 303-752-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019029151
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number019029151
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDEN.00205893
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4250-21
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: