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NPI Code Detail

MEDICARE: JORDAN J. HUMBERT DDS PC

MEDICARE: JORDAN J. HUMBERT DDS PC
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
1122300000XDentist201788CO

General Provider Information

NPI Number : 1578948857
Entity Type Code : Organization
Provider Name (Legal Business Name) : JORDAN J. HUMBERT DDS PC
Provider Business Mailing Address
First Line : 1001 CENTRE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-6047
Country : US
Telephone Number : 970-407-1001
Fax Number : 970-407-1581
Provider Business Practice Location Address
First Line : 1001 CENTRE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-6047
Country : US
Telephone Number : 970-407-1001
Fax Number : 970-407-1581
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. LOIS YOUNIE
Credential :
Telephone Number : 970-407-1001
Provider Enumeration Date : 07/28/2015
Last Update Date : 07/28/2015

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