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General NPI Number Information
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NPI Number | 1316469711
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Entity Type | Organization
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Legal Business Name | BOULDENT, LLC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4550 BROADWAY ST UNIT C-3E
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City | BOULDER
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State | CO
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Zip | 80304-4801
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Country | US
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Telephone | 720-504-8745
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 BROADWAY ST UNIT C-3E
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City | BOULDER
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State | CO
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Zip | 80304-4801
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Country | US
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Telephone | 720-504-8745
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTISTRY
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Name | DR. DAVID JONATHAN YEATS
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Credential | DMD
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Telephone | 303-444-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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