Provider Demographics
NPI:1952820631
Name:FOX CREEK FAMILY DENTAL LOVELAND
Entity Type:Organization
Organization Name:FOX CREEK FAMILY DENTAL LOVELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-772-9966
Mailing Address - Street 1:1490 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-2349
Mailing Address - Country:US
Mailing Address - Phone:720-458-6401
Mailing Address - Fax:
Practice Address - Street 1:1490 10TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-2349
Practice Address - Country:US
Practice Address - Phone:720-458-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental