MEDICARE: DENTAL SPECIALISTS OF FORT COLLINS

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	1223P0700X	Prosthodontics
2	122300000X	Dentist

General Provider Information

NPI Number	:	1235960394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SPECIALISTS OF FORT COLLINS

Provider Business Mailing Address
First Line	:	11005 S PARKER RD
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-7441
Country	:	US
Telephone Number	:	720-522-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 JOHN F KENNEDY PKWY UNIT E
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3074
Country	:	US
Telephone Number	:	970-673-7900
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS PARTNER
Name	:	RON BERGLOFF
Credential	:
Telephone Number	:	720-431-6060

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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