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General NPI Number Information
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NPI Number | 1790141539
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Entity Type | Organization
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Legal Business Name | INTEGRITY DENTAL OF BOULDER, LTD
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Dates
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Enumeration Date | 01/09/2016
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Last Update Date | 01/09/2016
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Provider Practice Location Address
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Address Line | 777 29TH ST STE. #300
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City | BOULDER
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State | CO
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Zip | 80303-2358
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Country | US
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Telephone | 303-442-6141
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Fax | 303-545-5669
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Provider Business Mailing Address
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Address Line | 305 IRWIN PL
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City | ERIE
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State | CO
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Zip | 80516-6554
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Country | US
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Telephone | 303-442-6141
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Fax | 303-545-5669
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORBETT W SUMMERS II
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Credential |
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Telephone | 303-442-6141
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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 | 5129
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License Number State | CO
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