Provider Demographics
NPI:1275013641
Name:PASS, DAVID ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:PASS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 YEARLING DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4494
Mailing Address - Country:US
Mailing Address - Phone:929-256-0156
Mailing Address - Fax:
Practice Address - Street 1:3531 S COLLEGE AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2642
Practice Address - Country:US
Practice Address - Phone:970-498-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001908122300000X
CODEN.00205474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist