NPIMap

Organization Active NPI

Boulder Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Boulder, CO
National Provider Identifier
1467967307
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
9410 Issued in CO
Legal business name
BOULDER ORAL SURGERY
Practice address
3450 Penrose PL Ste 120
Boulder, CO 80301-1800
Phone
(303) 447-9735
Fax
(303) 447-9735
NPI assigned
Dec 13, 2017
Organization subpart
Yes
Parent organization
TERRENCE NEDBALSKI DDS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Terrence Robert Nedbalski, DDSNPI 1477761062
Title
Owner
Phone
(303) 447-9735

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 9410 CO Primary

Addresses

Primary practice location

3450 Penrose PL Ste 120
Boulder, CO 80301-1800

Mailing address

3450 Penrose PL
Suite 120
Boulder, CO 80301-1800
Phone (303) 447-9735

Other practice location 1

1325 Hover St Ste 101
Longmont, CO 80501-3137
Phone (303) 772-8585

Other names 1

  • Boulder Oral Surgery Doing business as

National Provider Directory

National Provider Directory
Part of
Boulder Oral Surgery

Locations

3450 Penrose Pl
Ste 120
Boulder, CO 80301
Phone (303) 447-9735

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1467967307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 PENROSE PL",
            "address_2": "SUITE 120",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011800",
            "telephone_number": "303-447-9735",
            "fax_number": "303-447-1025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 PENROSE PL STE 120",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011800",
            "telephone_number": "303-447-9735",
            "fax_number": "303-447-9735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Hover St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805013137",
            "country_code": "US",
            "telephone_number": "303-772-8585",
            "fax_number": "303-776-4895",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOULDER ORAL SURGERY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TERRENCE NEDBALSKI DDS PLLC",
        "enumeration_date": "2017-12-13",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "NEDBALSKI",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-447-9735",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "9410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.