Provider Demographics
NPI:1598235814
Name:ALTITUDE FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:ALTITUDE FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-328-6848
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-4370
Mailing Address - Country:US
Mailing Address - Phone:970-328-6848
Mailing Address - Fax:970-328-1185
Practice Address - Street 1:35 LINDBERGH DR. SUITE 107
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637
Practice Address - Country:US
Practice Address - Phone:970-328-6848
Practice Address - Fax:970-328-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty