Provider Demographics
NPI:1144593393
Name:WINDSOR FRONT RANGE DENTISTRY
Entity Type:Organization
Organization Name:WINDSOR FRONT RANGE DENTISTRY
Other - Org Name:DBA WINDSOR FAMILY DENTISTRY, DBA WELLINGTON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-686-1186
Mailing Address - Street 1:1160 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4666
Mailing Address - Country:US
Mailing Address - Phone:970-686-1186
Mailing Address - Fax:970-686-1248
Practice Address - Street 1:1160 W ASH ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4666
Practice Address - Country:US
Practice Address - Phone:970-686-1186
Practice Address - Fax:970-686-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7943122300000X
CO10097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty