Active NPI
Peggy Ann Derloshon, DDS
- Public Health Dentistry
- Fort Collins, CO
National Provider Identifier
1336316579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 6629
- Practice address
- 120 Bristlecone Dr
Fort Collins, CO 80524-2031 - Phone
- (970) 224-5209
- Fax
- (970) 221-7165
- NPI assigned
- May 15, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 6629 | CO | Primary |
Addresses
Primary practice location
120 Bristlecone Dr
Fort Collins, CO 80524-2031
Mailing address
120 Bristlecone Dr
Fort Collins, CO 80524-2031
Phone (970) 224-5209
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6629 | CO | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210809600000",
"number": "1336316579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 BRISTLECONE DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242031",
"telephone_number": "970-224-5209",
"fax_number": "970-221-7165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 BRISTLECONE DR",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805242031",
"telephone_number": "970-224-5209",
"fax_number": "970-221-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERLOSHON",
"first_name": "PEGGY",
"middle_name": "ANN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-15",
"last_updated": "2008-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "CO",
"license": "6629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.