MEDICARE: DUSTIN FORD DDS

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	1223G0001X	General Practice Dentistry	53991	CA
2	1223G0001X	General Practice Dentistry	00202445	CO

General Provider Information

NPI Number	:	1619989670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN FORD DDS

Provider Business Mailing Address
First Line	:	777 BANNOCK ST # MC1923
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4507
Country	:	US
Telephone Number	:	303-436-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 BANNOCK ST FL 7
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-4506
Country	:	US
Telephone Number	:	303-602-8200
Fax Number	:	303-602-8206

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	02/08/2022

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Directions to “ DUSTIN FORD DDS” Practice Location

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