Healthcare Provider Details

I. General information

NPI: 1174658157
Provider Name (Legal Business Name): JULIO SEKLER DMD, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 SUMMERLIN PL
LONGMONT CO
80503-3921
US

IV. Provider business mailing address

4710 SUMMERLIN PL
LONGMONT CO
80503-3921
US

V. Phone/Fax

Practice location:
  • Phone: 720-606-3682
  • Fax:
Mailing address:
  • Phone: 720-606-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN16067
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10746
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: