Integrated Dermatology of Boulder Creek, LLC

NPI #1568033066 in Superior, Colorado

Provider Information

NPI Number: 1568033066
Entity Type: Organization
Organization Name: Integrated Dermatology of Boulder Creek, LLC
Primary Specialty: Dermatology
Enumeration Date: Jul 6, 2021
Last Updated: Jul 6, 2021

Practice Location

Address: 400 S MCCASLIN BLVD STE 100
City: Superior
State: Colorado
ZIP Code: 80027-9701
Phone: (303) 666-5261

Authorized Official

Name: DAVID FUENTES
Title: AUTHORIZED
Phone: (561) 314-2000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology - MOHS-Micrographic Surgery — MOHS-Micrographic Surgery	207ND0101X
Physician Assistant	363A00000X
Dermatology	207N00000X	Primary

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