MEDICARE: RYAN LEVI ULIBARRI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DEN00202189	CO
2	122300000X	Dentist	DEN.00202189	CO

General Provider Information

NPI Number	:	1477854396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LEVI ULIBARRI DDS

Provider Business Mailing Address
First Line	:	4745 BOARDWALK DR UNIT C2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3769
Country	:	US
Telephone Number	:	970-224-5599
Fax Number	:	970-224-5599

Provider Business Practice Location Address
First Line	:	4745 E BOARDWALK DR UNIT C2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3769
Country	:	US
Telephone Number	:	970-224-5599
Fax Number	:	970-224-0731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	07/12/2021

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