Provider Demographics
NPI:1699479618
Name:RYAN LEVI ULIBARRI DDS
Entity type:Organization
Organization Name:RYAN LEVI ULIBARRI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:970-224-5599
Mailing Address - Street 1:4745 BOARDWALK DR UNIT C2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3769
Mailing Address - Country:US
Mailing Address - Phone:970-224-5599
Mailing Address - Fax:
Practice Address - Street 1:4745 BOARDWALK DR UNIT C2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3769
Practice Address - Country:US
Practice Address - Phone:970-224-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental