Active NPI
Robert Jordan Baxt, D.D.S.
- General Practice Dentistry
- Boulder, CO
National Provider Identifier
1265449664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 104204
- Practice address
- 2718 S Lakeridge TRL
Boulder, CO 80302-9373 - Phone
- (303) 447-8756
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 104204 | CO | Primary |
Addresses
Primary practice location
2718 S Lakeridge TRL
Boulder, CO 80302-9373
Mailing address
2718 S Lakeridge TRL
Boulder, CO 80302-9373
Phone (303) 447-8756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104204 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265449664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2718 S LAKERIDGE TRL",
"city": "BOULDER",
"state": "CO",
"postal_code": "803029373",
"telephone_number": "303-447-8756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2718 S LAKERIDGE TRL",
"city": "BOULDER",
"state": "CO",
"postal_code": "803029373",
"telephone_number": "303-447-8756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAXT",
"first_name": "ROBERT",
"middle_name": "JORDAN",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "104204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.