MEDICARE: MOUNTAIN KIDS ORTHODONTICS LLC

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	:	1356103394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN KIDS ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	260 E HORSETOOTH RD STE 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3124
Country	:	US
Telephone Number	:	970-224-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 E HORSETOOTH RD STE 120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3124
Country	:	US
Telephone Number	:	970-224-3600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH GUIDO
Credential	:	MS DDS
Telephone Number	:	970-672-7525

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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