Organization · Type 2 NPI

My Local Colorado Dental Practice, LLC

General Practice Dentistry · Fort Collins, CO

NPI number 1548814262 Active

Practice location

3617 S College Ave Unit B
Fort Collins, CO 80525-3009

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry Primary	1223G0001X	None listed

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Another provider at this address

College Ave Modern Dental Practice, LLCDentist Fort Collins, CO NPI 1205358017

Other general practice dentistry providers in Fort Collins

See all in Fort Collins →

NPI record

NPI: 1548814262
Entity type: Organization (Type 2)
Issued: Jul 31, 2019
Last updated: Jul 31, 2019
Status: Active
Subpart: Yes of My Local Colorado Dental Practice, LLC

Other names

College Ave Modern Dental · doing business as

Authorized official

Michelle Johnson
Credentialing Specialist
(509) 315-8338

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1548814262

My Local Colorado Dental Practice, LLC's National Provider Identifier is 1548814262, issued on Jul 31, 2019. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Fort Collins, CO. The record was last updated on Jul 31, 2019.