Provider Demographics
NPI:1245446889
Name:CLEEVES, VINCENT F JR (DENTIST)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:F
Last Name:CLEEVES
Suffix:JR
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 PEARL ST STE 230
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5061
Mailing Address - Country:US
Mailing Address - Phone:303-449-8875
Mailing Address - Fax:303-546-9671
Practice Address - Street 1:767 PEARL ST STE 230
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5061
Practice Address - Country:US
Practice Address - Phone:303-449-8875
Practice Address - Fax:303-546-9671
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice