MEDICARE: DR. KATHRYN ANN RADTKE D.D.S.

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	122300000X	Dentist	8604	CO

General Provider Information

NPI Number	:	1386643955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN ANN RADTKE D.D.S.

Provider Business Mailing Address
First Line	:	2720 COUNCIL TREE AVE STE 260
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6330
Country	:	US
Telephone Number	:	970-673-7321
Fax Number	:	970-472-0440

Provider Business Practice Location Address
First Line	:	120 BRISTLECONE DR
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80524-2031
Country	:	US
Telephone Number	:	970-416-5331
Fax Number	:	970-472-0440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/21/2024

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