Healthcare Provider Details

I. General information

NPI: 1275450595
Provider Name (Legal Business Name): NILES MAD SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 2ND AVE UNIT 101
NIWOT CO
80544-5030
US

IV. Provider business mailing address

136 2ND AVE UNIT 101
NIWOT CO
80544-5030
US

V. Phone/Fax

Practice location:
  • Phone: 303-652-0400
  • Fax: 720-684-6029
Mailing address:
  • Phone: 303-652-0400
  • Fax: 720-684-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NILES
Title or Position: OWNER
Credential: DDS
Phone: 303-652-0400