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General NPI Number Information
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NPI Number | 1396131306
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Entity Type | Organization
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Legal Business Name | JUDITH TIMCHULA DDS, PC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 7490 CLUBHOUSE RD SUITE 101
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City | BOULDER
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State | CO
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Zip | 80301-3720
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Country | US
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Telephone | 303-530-1212
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Fax | 303-530-1702
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Provider Business Mailing Address
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Address Line | 7490 CLUBHOUSE RD SUITE 101
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City | BOULDER
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State | CO
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Zip | 80301-3720
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Country | US
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Telephone | 303-530-1212
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Fax | 303-530-1702
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH A TIMCHULA
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Credential | DDS
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Telephone | 303-530-1212
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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 | 5160
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License Number State | CO
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