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General NPI Number Information
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NPI Number | 1972981421
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Entity Type | Organization
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Legal Business Name | HIGH PLAINS ORTHODONTICS PLLC
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 109 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 | 970-867-9464
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Fax | 970-867-9465
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Provider Business Mailing Address
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Address Line | 109 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 | 970-867-9464
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Fax | 970-867-9465
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ROBERT LEROY WILHELM
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Credential | DDS
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Telephone | 970-867-9464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3146
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License Number State | CO
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