Provider Demographics
NPI:1134098718
Name:EXPERIENCE DENTAL 3 PLLC
Entity type:Organization
Organization Name:EXPERIENCE DENTAL 3 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-473-7706
Mailing Address - Street 1:123 N COLLEGE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2489
Mailing Address - Country:US
Mailing Address - Phone:970-473-7706
Mailing Address - Fax:
Practice Address - Street 1:123 N COLLEGE AVE STE 212
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2489
Practice Address - Country:US
Practice Address - Phone:970-473-7706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty