MEDICARE: NCDI LOVELAND PROFESSIONAL, LLP

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	1223P0221X	Pediatric Dentistry	6177	CO

General Provider Information

NPI Number	:	1144699604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NCDI LOVELAND PROFESSIONAL, LLP

Provider Business Mailing Address
First Line	:	272 E 29TH ST STE 274
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2733
Country	:	US
Telephone Number	:	970-669-1122
Fax Number	:	970-669-1984

Provider Business Practice Location Address
First Line	:	2700 MADISON SQUARE DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3385
Country	:	US
Telephone Number	:	970-669-1122
Fax Number	:	970-669-1984

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BLANCA RICHARDSON
Credential	:
Telephone Number	:	970-669-1122

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	08/05/2021

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