Healthcare Provider Details

I. General information

NPI: 1649904236
Provider Name (Legal Business Name): GARLOCK FIRESTONE ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/18/2025
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 ESTHER CIRCLE
FREDERICK CO
80504
US

IV. Provider business mailing address

7613 ESTHER CIRCLE
FREDERICK CO
80504
US

V. Phone/Fax

Practice location:
  • Phone: 303-848-3633
  • Fax: 303-253-9213
Mailing address:
  • Phone: 303-848-3633
  • Fax: 303-253-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID GARLOCK
Title or Position: ORTHODONTIST
Credential:
Phone: 303-848-3633