Provider Demographics
NPI:1760677504
Name:FC ONE, PC
Entity Type:Organization
Organization Name:FC ONE, PC
Other - Org Name:AABSOLUTELY SMILES FORT COLLINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AAB
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-377-9554
Mailing Address - Street 1:155 W HARVARD ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5200
Mailing Address - Country:US
Mailing Address - Phone:970-377-9554
Mailing Address - Fax:
Practice Address - Street 1:155 W HARVARD ST
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5200
Practice Address - Country:US
Practice Address - Phone:970-377-9554
Practice Address - Fax:970-377-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201450261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental