# BOULDER ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TERRENCE NEDBALSKI DDS PLLC
- **Other names:** Boulder Oral Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467967307
- **Legal business name:** TERRENCE NEDBALSKI DDS PLLC
- **Authorized official:** DR. TERRENCE ROBERT NEDBALSKI DDS (OWNER)
- **Authorized official phone:** (303) 447-9735

## Contact information

- **Practice address:** 3450 PENROSE PL STE 120, BOULDER, CO 80301-1800
- **Practice address phone:** (303) 447-9735
- **Practice address fax:** (303) 447-9735
- **Mailing address:** 3450 PENROSE PL, SUITE 120, BOULDER, CO 80301-1800
- **Mailing address phone:** (303) 447-9735
- **Mailing address fax:** (303) 447-1025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 9410 | CO | Yes |

## Other

- **Enumeration date:** 12/13/2017
- **Last updated:** 03/17/2018