Provider Demographics
NPI:1063084481
Name:BOULDER ORTHODONTICS
Entity type:Organization
Organization Name:BOULDER ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMON
Authorized Official - Middle Name:VERL
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-833-0310
Mailing Address - Street 1:2710 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3814
Mailing Address - Country:US
Mailing Address - Phone:303-449-3250
Mailing Address - Fax:303-449-1693
Practice Address - Street 1:704 1ST ST
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80520-5006
Practice Address - Country:US
Practice Address - Phone:303-833-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOULDER ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty