Healthcare Provider Details

I. General information

NPI: 1659868032
Provider Name (Legal Business Name): VSI PROVIDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 07/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DRY CREEK DRIVE SUITE 200
LONGMONT CO
80503
US

IV. Provider business mailing address

1630 DRY CREEK DRIVE SUITE 200
LONGMONT CO
80503
US

V. Phone/Fax

Practice location:
  • Phone: 970-699-7194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MRS. JODI POLLOCK
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 561-543-0563