Provider Demographics
NPI:1881926970
Name:ENDODONTICS OF THE ROCKIES
Entity type:Organization
Organization Name:ENDODONTICS OF THE ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-568-5255
Mailing Address - Street 1:2038 VERMONT DR
Mailing Address - Street 2:STE 201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5754
Mailing Address - Country:US
Mailing Address - Phone:970-568-5255
Mailing Address - Fax:
Practice Address - Street 1:2038 VERMONT DR
Practice Address - Street 2:STE 201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5754
Practice Address - Country:US
Practice Address - Phone:970-568-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty