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SOUTH BOULDER PEDIATRIC DENTISTRY
NPI 1972287217
Dentist - Pediatric Dentistry in Boulder, CO

Active since June 14, 2023
805 S BROADWAY ST STE 103, BOULDER, CO 80305(720) 441-2974 Get Directions Write a Review

NPPES record last updated: June 14, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About South Boulder Pediatric Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTH BOULDER PEDIATRIC DENTISTRY (NPI 1972287217) is a healthcare organization registered as a pediatric dentistry in Boulder, Colorado and active in the NPI registry since June 2023. The organization lists Samantha Graffeo Gardner, Owner/pediatric Dentist, as its authorized official.

NPPES Registry Identity

NPI1972287217
Entity TypeOrganization
Primary Taxonomy1223P0221X
Legal Business NameSOUTH BOULDER PEDIATRIC DENTISTRY
Location Address805 S BROADWAY ST STE 103Boulder, CO 80305-5972
Mailing Address2945 Moorhead AveBoulder, CO 80305-3342 · (720) 441-2974
Phone(720) 441-2974
Organization SubpartNo
Authorized OfficialSamantha Graffeo GardnerOwner/pediatric Dentist · (720) 441-2974
Enumeration DateJune 14, 2023
NPPES CertifiedJune 14, 2023
✔ NPI 1972287217 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

805 S BROADWAY ST STE 103, Boulder, CO 80305
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. BARBARA JO FRANKLIN FNP
Nurse Practitioner (Family)
805 S BROADWAY ST STE 103
BOULDER, CO 80305
Boulder County (303) 835-9523
MRS. RUTH ANN BENTLEY FNP-C
Nurse Practitioner (Family)
805 S BROADWAY ST STE 103
BOULDER, CO 80305
Boulder County (303) 499-0176

Frequently Asked Questions

What is SOUTH BOULDER PEDIATRIC DENTISTRY's NPI number?

The NPI number assigned to this healthcare provider is 1972287217, enumerated as an "organization" on June 14, 2023.

Where is the provider located?

The provider is located at 805 S BROADWAY ST STE 103 BOULDER, CO 80305 and the phone number is (720) 441-2974.

What is the provider's specialty?

Dentist with taxonomy code 1223P0221X and a focus in Pediatric Dentistry.