Healthcare Provider Details

I. General information

NPI: 1447420922
Provider Name (Legal Business Name): BLUESTEIN SURGICAL ARTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 W SOUTH BOULDER RD
LOUISVILLE CO
80027-2410
US

IV. Provider business mailing address

864 W SOUTH BOULDER RD SUITE 100
LOUISVILLE CO
80027-2410
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-1161
  • Fax:
Mailing address:
  • Phone: 303-938-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number30020765
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number8312
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number39080
License Number StateCO

VIII. Authorized Official

Name: DR. EVE BLUESTEIN
Title or Position: OWNER
Credential: MD, DDS
Phone: 303-938-1161