Provider Demographics
NPI:1083868988
Name:AESTHETIC & MAXILLOFACIAL ASSOCIATES
Entity type:Organization
Organization Name:AESTHETIC & MAXILLOFACIAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:720-878-8999
Mailing Address - Street 1:1610 CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5407
Mailing Address - Country:US
Mailing Address - Phone:303-938-0130
Mailing Address - Fax:303-245-0405
Practice Address - Street 1:1610 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5407
Practice Address - Country:US
Practice Address - Phone:303-938-0130
Practice Address - Fax:303-245-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty