Provider Demographics
NPI:1326494451
Name:FORT COLLINS KIDS DENTISTRY
Entity Type:Organization
Organization Name:FORT COLLINS KIDS DENTISTRY
Other - Org Name:FORT COLLINS KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBR
Authorized Official - Phone:970-672-7525
Mailing Address - Street 1:313 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-1954
Mailing Address - Country:US
Mailing Address - Phone:970-672-7525
Mailing Address - Fax:
Practice Address - Street 1:1241 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3204
Practice Address - Country:US
Practice Address - Phone:970-632-0306
Practice Address - Fax:970-797-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO027860921223D0004X
CO201611618401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41489268Medicaid
CO13430734Medicaid
CO90382587Medicaid