Organization
COLLEGE AVE MODERN DENTAL PRACTICE, LLC
Active
Other names
College Ave Modern Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT FREDERICK DDS (OWNER/DENTIST)
(970) 233-8933
Entity
Organization
Contact information
Practice address
3617 S COLLEGE AVE UNIT B, FORT COLLINS, CO 80525-3009
(970) 233-8933
(888) 790-7062
Mailing address
3617 S COLLEGE AVE UNIT B, FORT COLLINS, CO 80525-3009
(970) 233-8933
(888) 790-7062
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10115
CO
Other
Enumeration date
07/13/2017
Last updated
07/21/2022
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