My Local Colorado Dental Practice, LLC
NPI #1548814262 in Fort Collins, Colorado
Provider Information
- NPI Number
- 1548814262
- Entity Type
- Organization
- Organization Name
- My Local Colorado Dental Practice, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MY LOCAL COLORADO DENTAL PRACTICE, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jul 31, 2019
- Last Updated
- Jul 31, 2019
Practice Location
- Address
- 3617 S COLLEGE AVE UNIT B
- City
- Fort Collins
- State
- Colorado
- ZIP Code
- 80525-3009
- Phone
- (970) 233-8933
Authorized Official
- Name
- MICHELLE JOHNSON
- Title
- CREDENTIALING SPECIALIST
- Phone
- (509) 315-8338
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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