Healthcare Provider Details

I. General information

NPI: 1164610408
Provider Name (Legal Business Name): ANTHONY F. GIRARDI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 E PROSPECT RD UNIT B1
FORT COLLINS CO
80525-1367
US

IV. Provider business mailing address

1331 E. PROSPECT ROAD., UNIT B-1
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-232-3750
  • Fax: 970-232-3751
Mailing address:
  • Phone: 970-232-3750
  • Fax: 970-232-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number105172
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: