EXPERIENCE DENTAL PLLC NPI 1013568963

NPI Information

NPI: 1013568963
Provider Name: EXPERIENCE DENTAL PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
1933 28TH ST STE 204
BOULDER, CO
ZIP 80301
Phone: (740) 706-0765
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EXPERIENCE DENTAL PLLC is a dental clinic center in Boulder, CO. EXPERIENCE DENTAL PLLC NPI is 1013568963. The provider is registered as an organization entity type.

The provider's business location address is:

1933 28TH ST STE 204
BOULDER, CO
ZIP 80301-100
Phone: (740) 706-0765

The provider's authorized official is Jeremy Richard Altdorfer .
The authorized official title is Ceo and has the following contact phone number (740) 706-0765.

The enumeration date for this NPI number is 9/23/2019 and was last updated on 1/7/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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