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General NPI Number Information
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NPI Number | 1780196667
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF LOVELAND PLLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 2800 MADISON SQUARE DR STE 1
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City | LOVELAND
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State | CO
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Zip | 80538-3358
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Country | US
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Telephone | 970-669-7711
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Fax | 970-669-2491
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Provider Business Mailing Address
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Address Line | 2800 MADISON SQUARE DR STE 1
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City | LOVELAND
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State | CO
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Zip | 80538-3358
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Country | US
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Telephone | 970-669-7711
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Fax | 970-669-2491
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. KATHERINE SUZANNE GALM
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Credential | DDS
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Telephone | 970-669-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN-9679
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License Number State | CO
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