Provider Demographics
NPI:1770653891
Name:PATRICIAN, JEFFREY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:PATRICIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BALSAM AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3534
Mailing Address - Country:US
Mailing Address - Phone:410-330-0793
Mailing Address - Fax:
Practice Address - Street 1:4520 BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4800
Practice Address - Country:US
Practice Address - Phone:720-627-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist