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General NPI Number Information
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NPI Number | 1568965812
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Entity Type | Organization
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Legal Business Name | ADVANCED PROSTHODONTICS
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 1006 ROBERTSON ST STE 210
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City | FORT COLLINS
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State | CO
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Zip | 80524-3920
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Country | US
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Telephone | 970-493-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 ROBERTSON ST STE 210
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City | FORT COLLINS
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State | CO
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Zip | 80524-3920
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Country | US
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Telephone | 970-493-9001
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RON BERGLOFF
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Credential |
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Telephone | 720-431-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | D202404
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License Number State | CO
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