Organization
FOX CREEK FAMILY DENTAL LONGMONT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN KOENIG (OWNER)
(303) 772-9966
Entity
Organization
Contact information
Practice address
1610 PACE ST UNIT 100, LONGMONT, CO 80504-2239
(303) 772-9966
Mailing address
1610 PACE ST UNIT 100, LONGMONT, CO 80504-2239
(303) 772-9966
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/14/2017
Last updated
07/21/2022
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