Organization
TEQUILA SUNRISE BOULDER PLLC
Active
Other names
Dentistry of Colorado
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAUSHAL KUMAR DHAWAN DDS (MEMBER)
(417) 379-7923
Entity
Organization
Contact information
Practice address
4150 DARLEY AVE STE 7, BOULDER, CO 80305-6537
(303) 494-1550
Mailing address
4150 DARLEY AVE STE 7, BOULDER, CO 80305-6537
(303) 494-1550
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN0202080
DENTAL LICENSE
CO
Enumeration date
11/25/2020
Last updated
11/25/2020
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