PEDIATRIC DENTISTRY OF THE ROCKIES PLLC (NPI# 1144498999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144498999 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTISTRY OF THE ROCKIES PLLC |
| Other Organization Name | PEDIATRIC DENTISTRY OF THE ROCKIES |
| Practice Address |
4609 S Timberline Rd Suite 103b Fort Collins CO 80528-3170 |
| Practice Telephone | 9704844104 |
| Practice Fax Number | 9704845245 |
| Mailing Telephone | 9704844104 |
| Mailing Fax Number | 9704845245 |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2018-10-23 |
| Authorized Official Name | KEITH ALLEN VAN TASSELL (PRESIDENT/OWNER) |
| Authorized Official Telephone | 9704844104 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
9197 | CO | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 82906505 | 05 |
| Other Name | Type Code |
|---|---|
| Pediatric Dentistry of the Rockies | Doing Business As Name - Organization |
| Street Address |
4609 S TIMBERLINE RD SUITE 103B |
| City | FORT COLLINS |
| State | CO |
| Zip Code | 80528-3170 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477978872 | Zach Alleman | Dentist | 4609 S Timberline Rd, Suite 103b, Fort Collins, CO 80528-3170 | 2014-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518475391 | Corinna Kromer | Specialist | 4818 Snowdrift Circle, Fort Collins, CO 80528 | 2018-01-16 |
| 1447793419 | Suites Fort Collins LLC | Skilled Nursing Facility | 4880 Ziegler Rd, Fort Collins, CO 80528 | 2016-11-23 |
| 1790231413 | Pineridge Healthcare, Inc. | Skilled Nursing Facility | 4880 Ziegler Road, Fort Collins, CO 80528 | 2016-09-01 |
| 1750647244 | Annika Svea Kamberelis | Physician Assistant | 2121 E Harmony Rd Unit 300, Fort Collins, CO 80528 | 2012-04-09 |
| 1831481944 | Natasha E. Walter-fisk | Counselor | 5225 White Willow Dr. M220, Fort Collins, CO 80528 | 2011-05-07 |
| 1629216627 | Augusto Miravalle | Psychiatry & Neurology | 2121 E. Harmony Road, Suite 180, Ft Collins, CO 80528 | 2009-01-29 |
| 1114100252 | Alicia R. Young | Psychologist | 8010 S Country Road 5, Suite 201, Windsor, CO 80528 | 2007-12-12 |
| 1346446903 | Jill Marie Olson | Psychiatry & Neurology | 2121 E. Harmony Road #180, Fort Collins, CO 80528 | 2007-06-21 |
| 1437368578 | Shelley M Oliver | Orthopaedic Surgery | 2121 E. Harmony Rd. Ste 290, Fort Collins, CO 80528 | 2007-05-22 |
| 1174748008 | Light of The Rockies Christian Counseling Center | Clinic/Center | 5236 Strauss Cabin Rd, Fort Collins, CO 80528 | 2007-04-16 |
| Find all providers in zip 80528 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871850131 | Moira Gini Groh | Dentist | 2121 Midpoint Dr Ste 102, Fort Collins, CO 80525 | 2012-04-11 |
| 1568765105 | Mountain Kids Pediatric Dentistry | Dentist | 2016 Orchard Pl, Fort Collins, CO 80521-3213 | 2010-12-20 |
| 1760708127 | Joseph L Jackson | Dentist | 1241 Riverside Ave, Fort Collins, CO 80524-3204 | 2010-04-10 |
| 1366585408 | Keith Allen Van Tassell | Dentist | 2001 S Shields St Bldg A, Suite 2, Fort Collins, CO 80526-1827 | 2007-02-15 |
| 1215083142 | Gregory Dean Evans | Dentist | 3221 Eastbrook Dr, A-101, Fort Collins, CO 80525 | 2007-01-25 |
| 1992894562 | Jennifer K Hargleroad | Dentist | 2105 Bighorn Rd Ste 202, Fort Collins, CO 80525-3575 | 2006-10-12 |
| 1033207329 | Marykate Rusnak | Dentist | 3600 Mitchell Drive, Suite 40, Mountain Kids Pediatric Dentistry, Fort Collins, CO 80525 | 2006-10-11 |
| 1730635178 | Ncdi Drake, Professional LLP | Dentist | 383 W Drake Rd, Suite 103, Fort Collins, CO 80526-2884 | 2016-08-26 |
| 1275089617 | Ncdi Oak, Profession LLP | Dentist | 1220 Oak Park Dr, Fort Collins, CO 80525-7348 | 2016-08-26 |
| 1801277926 | Jennifer K Hargleroad Dds Ms Professional LLC | Dentist | 2105 Bighorn Rd, Suite 202, Fort Collins, CO 80525-3555 | 2015-06-15 |
| Find all providers in FORT COLLINS | ||||
| City | FORT COLLINS |
| Zip Code | 80528 |
Please comment or provide details below to improve the information on PEDIATRIC DENTISTRY OF THE ROCKIES PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.