Provider Demographics
NPI:1619691078
Name:NORTHERN COLORADO DENTAL SPECIALTY AND IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO DENTAL SPECIALTY AND IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
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:970-825-0000
Mailing Address - Street 1:1221 E ELIZABETH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4066
Mailing Address - Country:US
Mailing Address - Phone:970-825-0000
Mailing Address - Fax:
Practice Address - Street 1:1221 E ELIZABETH ST STE 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4066
Practice Address - Country:US
Practice Address - Phone:970-825-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty