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General NPI Number Information
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NPI Number | 1598235814
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Entity Type | Organization
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Legal Business Name | ALTITUDE FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 35 LINDBERGH DR. SUITE 107
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City | GYPSUM
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State | CO
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Zip | 81637
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Country | US
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Telephone | 970-328-6848
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Fax | 970-328-1185
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Provider Business Mailing Address
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Address Line | PO BOX 4370
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City | GYPSUM
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State | CO
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Zip | 81637-4370
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Country | US
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Telephone | 970-328-6848
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Fax | 970-328-1185
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY BERT ADAIR
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Credential | DMD
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Telephone | 970-328-6848
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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