Provider Demographics
NPI:1811075740
Name:ASSOCIATES IN FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:ASSOCIATES IN FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-223-6100
Mailing Address - Street 1:333 W DRAKE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2883
Mailing Address - Country:US
Mailing Address - Phone:970-223-6100
Mailing Address - Fax:970-226-4476
Practice Address - Street 1:333 W DRAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2883
Practice Address - Country:US
Practice Address - Phone:970-223-6100
Practice Address - Fax:970-226-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34011223G0001X
CO81201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty