MEDICARE: NCDI OAK, PROFESSION LLP

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1275089617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NCDI OAK, PROFESSION LLP

Provider Business Mailing Address
First Line	:	1220 OAK PARK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7348
Country	:	US
Telephone Number	:	970-223-8687
Fax Number	:	970-225-1574

Provider Business Practice Location Address
First Line	:	1220 OAK PARK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7348
Country	:	US
Telephone Number	:	970-223-8687
Fax Number	:	970-225-1574

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BLANCA CHAVEZ
Credential	:
Telephone Number	:	970-223-8687

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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