Individual provider Active NPI

Debbie Roubal, DDS

  • Dentist
  • Boulder, CO
National Provider Identifier
1760566533
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DEN8984 Issued in CO
Practice address
4155 Darley Ave Ste C
Boulder, CO 80305-6536
Phone
(303) 499-7072
Fax
(303) 200-7375
NPI assigned
Oct 25, 2006
Last updated
Jun 8, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DEN8984 CO Primary

Addresses

Primary practice location

4155 Darley Ave Ste C
Boulder, CO 80305-6536

Mailing address

877 E South Boulder Rd
Louisville, CO 80027-1345
Phone (303) 665-8228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160413001084 CO Order and Referring Only - DentistPractitioner - Dentist 6709184492

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DEN8984COMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Aid, Inc Dentist CurrentSince Jun 11, 2023 Accepting new patients
Debbie Roubal DDS, PC Dentist Past Accepting new patients

Locations

4155 Darley Ave
Ste C
Boulder, CO 80305
Phone (303) 499-7072

877 S Boulder Rd
Louisville, CO 80027
Phone (303) 665-8228

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1760566533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 E SOUTH BOULDER RD",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800271345",
            "telephone_number": "303-665-8228",
            "fax_number": "303-200-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 DARLEY AVE STE C",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803056536",
            "telephone_number": "303-499-7072",
            "fax_number": "303-200-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUBAL",
        "first_name": "DEBBIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN8984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.