MEDICARE: OPEN AND AFFORDABLE DENTAL FORT COLLINS SOUTH 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	122300000X	Dentist

General Provider Information

NPI Number	:	1659002160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN AND AFFORDABLE DENTAL FORT COLLINS SOUTH PLLC

Provider Business Mailing Address
First Line	:	3838 S TIMBERLINE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3415
Country	:	US
Telephone Number	:	970-632-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 S TIMBERLINE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3415
Country	:	US
Telephone Number	:	970-632-9006
Fax Number	:

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	JOSHUA PIPER
Credential	:	DDS
Telephone Number	:	620-755-2709

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/23/2022

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