Provider Demographics
NPI:1891238283
Name:FORT COLLINS DENTIST FAMILY & IMPLANT DENTISTRY PLLC
Entity Type:Organization
Organization Name:FORT COLLINS DENTIST FAMILY & IMPLANT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LESKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-221-5115
Mailing Address - Street 1:2001 S SHIELDS ST BUILDING L
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1489
Mailing Address - Country:US
Mailing Address - Phone:970-221-5115
Mailing Address - Fax:970-221-5136
Practice Address - Street 1:2001 S SHIELDS ST. BUILDING L
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1489
Practice Address - Country:US
Practice Address - Phone:970-221-5115
Practice Address - Fax:970-221-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty