Individual
DR. KEITH ALLEN VAN TASSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2001 S SHIELDS ST BLDG A, SUITE 2, FORT COLLINS, CO 80526-1827
(970) 484-4104
(970) 484-5245
Mailing address
2001 S SHIELDS ST BLDG A, SUITE 2, FORT COLLINS, CO 80526-1827
(970) 484-4104
(970) 484-5245
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9197
CO
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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