Pediatric Dentistry of the Rockies PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9197 Issued in CO

Legal business name

PEDIATRIC DENTISTRY OF THE ROCKIES PLLC

Doing business as

Pediatric Dentistry of the Rockies

Practice address

4609 S Timberline Rd
Suite 103B
Fort Collins, CO 80528-3170

Phone

(970) 484-4104

Fax

(970) 484-5245

NPI assigned

Feb 14, 2008

Organization subpart

No

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

Authorized official

Name

Keith Allen Van Tassell

Title

President/Owner

Phone

(970) 484-4104

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pediatric Dentistry of the Rockies Doing business as

Locations

Practitioners 1

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

• Zach Alleman, DDS

  • Pediatric Dentistry
  • Fort Collins, CO
  • NPI 1477978872
  NPD (past)

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1144498999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4609 S TIMBERLINE RD",
            "address_2": "SUITE 103B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283170",
            "telephone_number": "970-484-4104",
            "fax_number": "970-484-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4609 S TIMBERLINE RD",
            "address_2": "SUITE 103B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283170",
            "telephone_number": "970-484-4104",
            "fax_number": "970-484-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF THE ROCKIES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "VAN TASSELL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "970-484-4104"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "9197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82906505",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry of the Rockies",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pediatric Dentistry of the Rockies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Macy Pedersen
• Sonya Magdelano Pedersen, F.N.P.
• Barry D. M. Pederson, OTR
• Pediatric Associates of Fort Collins, PLLC
• Pediatric Associates of Northern Colorado
• Pediatric Occupational Therapy Services, LLC
• Andrea G Giselle Pedroza
• Shawna Pehrson
• Hailey Janette Peif, CRNA
• Theresa Victoria Berger Peirce, MS, RDN

• Pediatric Dentistry in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; 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.