NPIMap

Individual provider Active NPI

Jessica Allen, DMD

  • Periodontics
  • Fort Collins, CO
National Provider Identifier
1164719290
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
00203431 Issued in CO
Practice address
4033 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5937
Phone
(970) 207-4061
NPI assigned
Jul 10, 2011
Last updated
Dec 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 00203431 CO Primary
Periodontics 1223P0300X 1690 WY

Addresses

Primary practice location

4033 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5937

Mailing address

4033 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5937
Phone (970) 207-4061

Other practice location 1

7010 Yellowtail Rd Ste 200
Cheyenne, WY 82009-6113
Phone (307) 423-0325

Other practice location 2

1813 61st Ave Ste 210
Greeley, CO 80634-8059
Phone (970) 351-6166

Other names 1

  • Jessica Shreck Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
00203431COMDPeriodontist
1690WYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Colorado Periodontics Periodontics CurrentSince Dec 7, 2025 Accepting new patients
Southern Wyoming Periodontics LLC Periodontics Current Accepting new patients
Ed Deandrade DDS, LTD. Periodontics Past Accepting new patients
Anthem Periodontics and Dental Implants Periodontics Past Accepting new patients
Leslie J. Paris, D.D.S.,M.S.D.,P.C. Periodontics PastSince Dec 7, 2025 Accepting new patients

Locations

4033 Boardwalk Dr
Unit 100
Fort Collins, CO 80525
Phone (970) 207-4061

7010 Yellowtail Rd
Ste 200
Cheyenne, WY 82009
Phone (307) 423-0325

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1310256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1164719290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 BOARDWALK DR UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255937",
            "telephone_number": "970-207-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4033 BOARDWALK DR UNIT 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255937",
            "telephone_number": "970-207-4061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7010 Yellowtail Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820096113",
            "country_code": "US",
            "telephone_number": "307-423-0325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1813 61st Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806348059",
            "country_code": "US",
            "telephone_number": "970-351-6166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "JESSICA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-10",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "00203431",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WY",
            "license": "1690",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SHRECK",
            "credential": "DMD, MSD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; 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.