Healthcare Provider Details

I. General information

NPI: 1164719290
Provider Name (Legal Business Name): JESSICA ALLEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA SHRECK DMD, MSD

II. Dates (important events)

Enumeration Date: 07/10/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 BOARDWALK DR UNIT 100
FORT COLLINS CO
80525-5937
US

IV. Provider business mailing address

4033 BOARDWALK DR UNIT 100
FORT COLLINS CO
80525-5937
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4061
  • Fax:
Mailing address:
  • Phone: 970-207-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number00203431
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1690
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: