# EXPERIENCE DENTAL HYGIENE PRACTICE 1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Experience Dental Hygiene
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992484844
- **Authorized official:** DR. JEREMY ALTDORFER DDS (CEO EXTRORDINAIRE)
- **Authorized official phone:** (720) 645-1226

## Contact information

- **Practice address:** 3125 28TH ST, BOULDER, CO 80301-1315
- **Practice address phone:** (720) 996-0559
- **Practice address fax:** (720) 740-6760
- **Mailing address:** 3125 28TH ST, BOULDER, CO 80301-1315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2023
- **Last updated:** 06/15/2026