Organization
FORT MOGAN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TACI COOPER (OFFICE MANAGER)
(719) 383-2083
Entity
Organization
Contact information
Practice address
617 WEST PLATTE AVE, AREA A, FORT MORGAN, CO 80701-9306
(970) 867-4700
(970) 867-2128
Mailing address
617 WEST PLATTE AVE, AREA A, FORT MORGAN, CO 80701-9306
(970) 867-2128
(970) 867-2128
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
00202298
CO
1223G0001X
General Practice Dentistry
Primary
00202298
CO
Other
Enumeration date
03/10/2017
Last updated
03/10/2017
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