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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1699479618
Entity Type Code	:	Organization
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	:

Provider Business Practice Location 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	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CANDACE MARIE EDWARDS
Credential	:	CDA
Telephone Number	:	970-224-5599

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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