Healthcare Provider Details

I. General information

NPI: 1114025160
Provider Name (Legal Business Name): NEIL NEUGEBOREN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 E GIRARD AVE SUITE A- 209
DENVER CO
80231-5500
US

IV. Provider business mailing address

3690S YOSEMITE ST
DENVER CO
80237-1808
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-0990
  • Fax: 303-695-6915
Mailing address:
  • Phone: 303-695-0990
  • Fax: 303-695-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8231
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: