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General NPI Number Information
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NPI Number | 1114679057
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Entity Type | Organization
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Legal Business Name | NOCO ORTHO PLLC
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 1299 MAIN ST UNIT C
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City | WINDSOR
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State | CO
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Zip | 80550-5947
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Country | US
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Telephone | 970-674-0717
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Fax |
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Provider Business Mailing Address
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Address Line | 1299 MAIN ST UNIT C
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City | WINDSOR
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State | CO
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Zip | 80550-5947
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Country | US
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Telephone | 970-674-0717
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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