Provider Demographics
NPI:1568965812
Name:ADVANCED PROSTHODONTICS
Entity Type:Organization
Organization Name:ADVANCED PROSTHODONTICS
Other - Org Name:FRONT RANGE DENTURES AND PROSTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-431-6060
Mailing Address - Street 1:1006 ROBERTSON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3920
Mailing Address - Country:US
Mailing Address - Phone:970-493-9001
Mailing Address - Fax:
Practice Address - Street 1:1006 ROBERTSON ST STE 210
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3920
Practice Address - Country:US
Practice Address - Phone:970-493-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COD2024041223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty