Provider Demographics
NPI:1689675407
Name:MILOS VALSTAD, PAMELA SUSANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUSANNE
Last Name:MILOS VALSTAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BASSETERRE PLACE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-207-4024
Mailing Address - Fax:970-207-4024
Practice Address - Street 1:519 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-686-7121
Practice Address - Fax:970-686-1021
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7737OtherDENTAL LICENSE NUMBER