Fort Mogan Dental LLC

NPI #1033650015 in Fort Morgan, Colorado

Provider Information

NPI Number: 1033650015
Entity Type: Organization
Organization Name: Fort Mogan Dental LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 10, 2017
Last Updated: Mar 10, 2017

Practice Location

Address: 617 WEST PLATTE AVE
Address 2: AREA A
City: Fort Morgan
State: Colorado
ZIP Code: 80701-9306
Phone: (970) 867-4700

Authorized Official

Name: TACI COOPER
Title: OFFICE MANAGER
Phone: (719) 383-2083

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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