1689092835 NPI number — PERFECT TEETH - NORTH COLLEGE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689092835 NPI number — PERFECT TEETH - NORTH COLLEGE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFECT TEETH - NORTH COLLEGE P.C.
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:
Provider Other Organization Name Type Code:
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:
1689092835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1856 N. COLLEGE AVENUE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-484-0080
Provider Business Mailing Address Fax Number:
970-484-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1856 N. COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-484-0080
Provider Business Practice Location Address Fax Number:
970-484-0090
Provider Enumeration Date:
04/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, RCM
Authorized Official Telephone Number:
972-930-7707

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6097 , 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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