Marisa Elizabeth Patt, DMD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

00203089 Issued in CO

Practice address

7490 Clubhouse Rd Ste 101
Boulder, CO 80301-3720

Phone

(303) 530-1212

NPI assigned

Jul 20, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 16, 2018 through Jul 16, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Judith Timchula DDS, PC

  • Dental Clinic/Center
  • Boulder, CO
  • NPI 1396131306
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1124331004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 MADISON AVE",
            "address_2": "STE 1208",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100221907",
            "telephone_number": "212-371-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7490 CLUBHOUSE RD STE 101",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013720",
            "telephone_number": "303-530-1212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5400 Idylwild Trl",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "80301",
            "country_code": "US",
            "telephone_number": "303-530-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATT",
        "first_name": "MARISA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-20",
        "last_updated": "2023-07-06",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CO",
            "license": "00203089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Alexis Patel
• Mira VK Patel
• Jeffrey Michael Patrician, D.D.S.
• Liza Dylan Patrick, CNM
• Shannon Patrick
• Alicia Patterson
• David C. Patterson, PH. D.
• Kerry Faye Patterson, RN. NP
• Kimberly M Patterson, MD
• Roy Patterson, MA, BCBA

• Prosthodontics in Boulder, CO
• Providers in Boulder, CO by specialty
• Prosthodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.