Fort Mogan Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00202298 Issued in CO

Legal business name

FORT MOGAN DENTAL LLC

Practice address

617 West Platte Ave
Area a
Fort Morgan, CO 80701-9306

Phone

(970) 867-4700

Fax

(970) 867-2128

NPI assigned

Mar 10, 2017

Last updated

Mar 10, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Taci Cooper

Title

Office Manager

Phone

(719) 383-2083

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489104000000",
    "number": "1033650015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 WEST PLATTE AVE",
            "address_2": "AREA A",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807019306",
            "telephone_number": "970-867-2128",
            "fax_number": "970-867-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 WEST PLATTE AVE",
            "address_2": "AREA A",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807019306",
            "telephone_number": "970-867-4700",
            "fax_number": "970-867-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MOGAN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-10",
        "last_updated": "2017-03-10",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "TACI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-383-2083"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00202298",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00202298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Practice Clinic, PC
• Bonnie Fisher
• Tracy Wayne Fisher, RD
• Rosita Flores
• Michael Foncannon, PHARMD, RPH
• Fort Morgan Eye Care LLC
• Fort Morgan Family Dental
• Fort Morgan Medical Group, PC
• Fort Morgan Orthodontic Center
• Fort Morgan Pediatric Clinic

• General Practice Dentistry in Fort Morgan, CO
• Providers in Fort Morgan, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.