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General NPI Number Information
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NPI Number | 1619691078
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Entity Type | Organization
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Legal Business Name | NORTHERN COLORADO DENTAL SPECIALTY AND IMPLANT CENTER PLLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 1221 E ELIZABETH ST STE 4
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City | FORT COLLINS
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State | CO
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Zip | 80524-4066
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Country | US
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Telephone | 970-825-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 E ELIZABETH ST STE 4
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City | FORT COLLINS
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State | CO
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Zip | 80524-4066
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Country | US
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Telephone | 970-825-0000
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | RON BERGLOFF
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Credential |
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Telephone | 970-825-0000
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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 |
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License Number State |
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