MEDICARE: NOCO ORTHO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1114679057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOCO ORTHO PLLC

Provider Business Mailing Address
First Line	:	1299 MAIN ST UNIT C
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-5947
Country	:	US
Telephone Number	:	970-674-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 MAIN ST UNIT C
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-5947
Country	:	US
Telephone Number	:	970-674-0717
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	FAITH GASKINS
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	01/21/2022

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Directions to “NOCO ORTHO PLLC ” Practice Location

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