Healthcare Provider Details

I. General information

NPI: 1821481086
Provider Name (Legal Business Name): MARIE SHIDLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W SOUTH BOULDER RD STE 102
LAFAYETTE CO
80026-8910
US

IV. Provider business mailing address

1140 W SOUTH BOULDER RD STE 102
LAFAYETTE CO
80026-8910
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-9500
  • Fax:
Mailing address:
  • Phone: 303-604-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDEN.00202586
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: