Healthcare Provider Details

I. General information

NPI: 1992894562
Provider Name (Legal Business Name): JENNIFER K HARGLEROAD D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 BIGHORN RD STE 202
FORT COLLINS CO
80525-3575
US

IV. Provider business mailing address

2105 BIGHORN RD STE 202
FORT COLLINS CO
80525-3575
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-2254
  • Fax: 970-493-0940
Mailing address:
  • Phone: 970-493-2254
  • Fax: 970-493-0940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8365
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier10025261500
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer
# 2
Identifier78907811
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 3
Identifier54182336
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: