Individual
DR. AUSTIN JEFFREY DEPORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1600 23RD AVE, SUITE 200, GREELEY, CO 80634-6071
(970) 353-4329
Mailing address
1600 23RD AVE, SUITE 200, GREELEY, CO 80634-6071
(970) 353-4329
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00202761
CO
122300000X
Dentist
019029653
IL
Other
Enumeration date
10/01/2013
Last updated
09/02/2016
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