Healthcare Provider Details

I. General information

NPI: 1578073904
Provider Name (Legal Business Name): PATRICK JOSEPH HOBLITZELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 SHERIDAN BLVD UNIT F
EDGEWATER CO
80214
US

IV. Provider business mailing address

1101 E BAYAUD AVE APT E1708
DENVER CO
80209-2498
US

V. Phone/Fax

Practice location:
  • Phone: 303-557-4056
  • Fax:
Mailing address:
  • Phone: 859-250-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00203555
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: