Provider Demographics
NPI:1861246902
Name:NORTH BOULDER DENTAL PARTNERS PLLP
Entity type:Organization
Organization Name:NORTH BOULDER DENTAL PARTNERS PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:PHILPOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-369-8678
Mailing Address - Street 1:10279 INSPIRATION DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8546
Mailing Address - Country:US
Mailing Address - Phone:217-369-8678
Mailing Address - Fax:
Practice Address - Street 1:4550 BROADWAY ST STE C-3E
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4801
Practice Address - Country:US
Practice Address - Phone:303-848-2906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty