Provider Demographics
NPI:1235960394
Name:DENTAL SPECIALISTS OF FORT COLLINS
Entity type:Organization
Organization Name:DENTAL SPECIALISTS OF FORT COLLINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-431-6060
Mailing Address - Street 1:11005 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7441
Mailing Address - Country:US
Mailing Address - Phone:720-522-2000
Mailing Address - Fax:
Practice Address - Street 1:3950 JOHN F KENNEDY PKWY UNIT E
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3074
Practice Address - Country:US
Practice Address - Phone:970-673-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty