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General NPI Number Information
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NPI Number | 1730433889
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Entity Type | Organization
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Legal Business Name | PLATTEVILLE FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/27/2012
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Last Update Date | 10/27/2012
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Provider Practice Location Address
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Address Line | 340 JUSTIN AVE SUITE 120
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City | PLATTEVILLE
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State | CO
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Zip | 80651-7800
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Country | US
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Telephone | 970-590-6205
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Fax |
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Provider Business Mailing Address
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Address Line | 417 BLUE LAKE TRL
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City | LAFAYETTE
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State | CO
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Zip | 80026-8893
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Country | US
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Telephone | 970-590-6205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BETH ANN DORIAN
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Credential | DMD
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Telephone | 970-590-6205
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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 | 10088
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License Number State | CO
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