Organization
MOUNTAIN RIDGE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN DEPORTER DMD (DENTIST, OWNER)
(970) 528-0900
Entity
Organization
Contact information
Practice address
310 MOUNTAIN AVE, BERTHOUD, CO 80513-5004
(970) 528-0900
Mailing address
310 MOUNTAIN AVE PO BOX 1694, PO BOX 1694, BERTHOUD, CO 80513
(970) 528-0900
(970) 528-9090
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2021
Last updated
09/23/2021
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