Organization
FOUNTAIN DENTAL PRACTICE, LLC
Active
Other names
Fountain Dental Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT FREDERICK DDS (OWNER/DOCTOR)
(719) 382-5500
Entity
Organization
Contact information
Practice address
8085 FOUNTAIN MESA RD, FOUNTAIN, CO 80817-1591
(719) 382-5500
(888) 790-7062
Mailing address
8085 FOUNTAIN MESA RD, FOUNTAIN, CO 80817-1591
(719) 382-5500
(888) 790-7062
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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