Healthcare Provider Details

I. General information

NPI: 1801990858
Provider Name (Legal Business Name): ROBERT TEITELBAUM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W JEWELL AVE STE 2
LAKEWOOD CO
80232-7102
US

IV. Provider business mailing address

6565 W JEWELL AVE STE 2
LAKEWOOD CO
80232-7102
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-0444
  • Fax:
Mailing address:
  • Phone: 303-458-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberHD 105231
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: