1306363429 NPI number — WINDSOR FAMILY DENTISTRY PRACTICE, LLC

Table of content: (NPI 1306363429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306363429 NPI number — WINDSOR FAMILY DENTISTRY PRACTICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSOR FAMILY DENTISTRY PRACTICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINDSOR FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306363429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6020 N CAREFREE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80922-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-266-2717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 W ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80550-4666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-686-1186
Provider Business Practice Location Address Fax Number:
888-790-7062
Provider Enumeration Date:
08/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FREDERICK
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-686-1186

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10115 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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