NPIMap

Organization Active NPI

Fox Creek Family Dental Longmont

  • Dental Clinic/Center
  • Longmont, CO
National Provider Identifier
1053830737
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
FOX CREEK FAMILY DENTAL LONGMONT
Practice address
1610 Pace St Unit 100
Longmont, CO 80504-2239
Phone
(303) 772-9966
NPI assigned
Sep 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ryan Koenig
Title
Owner
Phone
(303) 772-9966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1610 Pace St Unit 100
Longmont, CO 80504-2239

Mailing address

1610 Pace St Unit 100
Longmont, CO 80504-2239
Phone (303) 772-9966

National Provider Directory

National Provider Directory

Locations

1610 Pace St
Unit 100
Longmont, CO 80504
Phone (303) 622-5399

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053830737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 PACE ST UNIT 100",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805042239",
            "telephone_number": "303-772-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 PACE ST UNIT 100",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805042239",
            "telephone_number": "303-772-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX CREEK FAMILY DENTAL LONGMONT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-772-9966"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.