Provider Demographics
NPI:1578644175
Name:NORTHWEST COLORADO DENTAL COALITION
Entity Type:Organization
Organization Name:NORTHWEST COLORADO DENTAL COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:970-824-1178
Mailing Address - Street 1:485 YAMPA AVENUE
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625
Mailing Address - Country:US
Mailing Address - Phone:970-824-1178
Mailing Address - Fax:970-824-1179
Practice Address - Street 1:485 YAMPA AVENUE
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625
Practice Address - Country:US
Practice Address - Phone:970-824-1178
Practice Address - Fax:970-824-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92235743Medicaid