NPIMap

Organization Active NPI

Northeast Family Dental Clinic

  • Dental Clinic/Center
  • Hastun, CO
National Provider Identifier
1154486272
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
CO8895 Issued in CO
Legal business name
NORTHEAST FAMILY DENTAL CLINIC
Practice address
115 South Colorado Ave
Hastun, CO 80731
Phone
(970) 774-7999
Fax
(970) 774-7997
NPI assigned
Dec 27, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Aaron C Wood
Title
Ceo
Phone
(970) 774-6123

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

National Provider Directory
Tax ID family
Haxtun Hospital District (5 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X CO8895 CO Primary

Addresses

NPPES NPI Registry

Primary practice location

115 South Colorado Ave
Hastun, CO 80731

Mailing address

PO Box 248
Haxtun, CO 80731
Phone (970) 774-7999

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154486272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 248",
            "city": "HAXTUN",
            "state": "CO",
            "postal_code": "80731",
            "telephone_number": "970-774-7999",
            "fax_number": "970-774-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SOUTH COLORADO AVE",
            "city": "HASTUN",
            "state": "CO",
            "postal_code": "80731",
            "telephone_number": "970-774-7999",
            "fax_number": "970-774-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FAMILY DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-774-6123"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CO",
            "license": "CO8895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.