MEDICARE: ADMIRE DENTAL OF FORT COLLINS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1013898469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMIRE DENTAL OF FORT COLLINS PLLC

Provider Business Mailing Address
First Line	:	360 QUEEN ST STE 205
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-1883
Country	:	US
Telephone Number	:	970-930-3396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 RIVERSIDE AVE UNIT 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4348
Country	:	US
Telephone Number	:	970-930-3396
Fax Number	:

Authorized Official
Title or Position	:	TRANSITIONS AND OPERATIONS MANAGER
Name	:	MAGGIE MCCLAIN
Credential	:
Telephone Number	:	860-269-0628

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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