Healthcare Provider Details

I. General information

NPI: 1770089732
Provider Name (Legal Business Name): FACETTE LIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HAXTON DR UNIT 100
FORT COLLINS CO
80525-6213
US

IV. Provider business mailing address

1100 HAXTON DR UNIT 100
FORT COLLINS CO
80525-6213
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-1211
  • Fax:
Mailing address:
  • Phone: 970-223-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000903720
License Number StateCO

VIII. Authorized Official

Name: ERIN L JONES
Title or Position: OWNER
Credential: RDH
Phone: 970-223-1211