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General NPI Number Information
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NPI Number | 1669977427
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Entity Type | Organization
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Legal Business Name | A COUNTRY DENTIST, PLLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 107 W 9TH AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-2011
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Country | US
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Telephone | 970-867-2502
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Fax | 970-867-3795
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Provider Business Mailing Address
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Address Line | 107 W 9TH AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-2011
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Country | US
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Telephone | 970-867-2502
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Fax | 970-867-3795
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Authorized Official
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Title or Position | MANAGER
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Name | DR. PASCO W SCARPELLA
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Credential | DDS
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Telephone | 303-335-8160
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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 | 106313
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License Number State | CO
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