Provider Demographics
NPI:1427140250
Name:ZELIE, STEPHEN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:ZELIE
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 1:12495 W 32ND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5288
Mailing Address - Country:US
Mailing Address - Phone:303-237-2707
Mailing Address - Fax:303-237-2680
Practice Address - Street 1:12495 W 32ND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-5288
Practice Address - Country:US
Practice Address - Phone:303-237-2707
Practice Address - Fax:303-237-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12OtherDENTIST