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General NPI Number Information
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NPI Number | 1063041374
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Entity Type | Organization
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Legal Business Name | RADIANT DENTAL HEALTH
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 313 W DRAKE RD
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City | FORT COLLINS
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State | CO
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Zip | 80526-2846
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Country | US
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Telephone | 970-422-1122
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Fax | 970-425-1243
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Provider Business Mailing Address
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Address Line | 313 W DRAKE RD
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City | FORT COLLINS
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State | CO
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Zip | 80526-2846
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Country | US
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Telephone | 970-422-1122
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Fax | 970-425-1243
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. NATHANIEL BOONE CALDON
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Credential | DMD
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Telephone | 970-422-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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