College Ave Modern Dental Practice, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

10115 Issued in CO

Legal business name

COLLEGE AVE MODERN DENTAL PRACTICE, LLC

Practice address

3617 S College Ave Unit B
Fort Collins, CO 80525-3009

Phone

(970) 233-8933

Fax

(888) 790-7062

NPI assigned

Jul 13, 2017

Organization subpart

No

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

Authorized official

Name

Scott Frederick, DDS

Title

Owner/Dentist

Phone

(970) 233-8933

Specialties & licenses 1

Addresses

Other names 1

• College Ave Modern Dental Doing business as

Locations

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1205358017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 S COLLEGE AVE UNIT B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253009",
            "telephone_number": "970-233-8933",
            "fax_number": "888-790-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 S COLLEGE AVE UNIT B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805253009",
            "telephone_number": "970-233-8933",
            "fax_number": "888-790-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE AVE MODERN DENTAL PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "970-233-8933",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "10115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Ave Modern Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "College Ave Modern Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nanette C Colip, MD
• Collaborative Care OT
• Collaborative Psychological
• Sariah R Collard
• Colleen K Sidhu
• Rachel Larae Collier, PT
• Collindale Dental General Partnership
• Alexandria Collins
• Allison M Collins
• Cynthia Collins, O.D.

• Dentist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Dentist in Colorado

• 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.