MEDICARE: DR. ALEXA CRETE DDS

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	122300000X	Dentist	DEN.00204812	CO

General Provider Information

NPI Number	:	1477123479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXA CRETE DDS

Provider Business Mailing Address
First Line	:	1000 N 5TH ST
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-5617
Country	:	US
Telephone Number	:	970-775-4348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1343 E PROSPECT RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1115
Country	:	US
Telephone Number	:	970-484-3959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	03/14/2022

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