My Local Colorado Dental Practice, LLC
Dentist, General Practice in Boulder, CO. Organization (NPI-2).
NPI number1982258653
StatusActive
Last updated in NPPESJul 30, 2019
Details
- NPI
- 1982258653
- Entity type
- Organization (NPI-2)
- Legal business name
- My Local Colorado Dental Practice, LLC
- Organization subpart
- Yes
- Enumeration date
- Jul 30, 2019
- Last updated
- Jul 30, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Sage Dental Care (Doing Business As)
Practice location
1844 Pearl StBoulder, CO 80302-5533
Phone 720-465-4382
Mailing address
1844 Pearl StBoulder, CO 80302-5533
Phone 720-465-4382
Authorized official
Michelle Johnson
Credentialing Specialist
5093158338
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