=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336090513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANITAS FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2026
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 767 PEARL ST STE 230
-----------------------------------------------------
City | BOULDER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80302-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-449-8875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2804 RIDGE RD
-----------------------------------------------------
City | NEDERLAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80466-9741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. KRISTA MICHEL ECKHOFF BESEDA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 720-339-8902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------