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Organization
FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS, LLP
Active
Organization
FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS, LLP
Active
Other names
Fountain Modern Dentistry and Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RODGERS (DDS/ OWNER)
(719) 382-4936
Entity
Organization
Contact information
Practice address
2860 MICHELLE DRIVE 2ND FLOOR, IRVINE, CA 92606
(714) 368-2077
(714) 368-2092
Mailing address
6940 MESA RIDGE PARKWAY, FOUNTAIN, CO 80817
(719) 382-4936
(719) 382-4938
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9356
CO
Other
Enumeration date
07/17/2012
Last updated
07/17/2012
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