NPIMap

Organization Active NPI

Mod LLC

  • Dental Clinic/Center
  • Fort Collins, CO
National Provider Identifier
1346679321
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MOD LLC
Practice address
2121 Midpoint Dr
Suite 102
Fort Collins, CO 80525-4339
Phone
(970) 484-5437
Fax
(970) 484-5436
NPI assigned
Nov 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

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

Authorized official

Name
Luke MilmontNPI 1760643696
Title
Pediatric Dentist
Phone
(307) 772-1793

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X CO Primary

Addresses

Primary practice location

2121 Midpoint Dr
Suite 102
Fort Collins, CO 80525-4339

Mailing address

2121 Midpoint Dr
Suite 102
Fort Collins, CO 80525-4339
Phone (970) 484-5437

Other names 1

  • KidsFirst Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2121 Midpoint Dr
Ste 102
Fort Collins, CO 80525
Phone (970) 484-5437

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1384128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1346679321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 MIDPOINT DR",
            "address_2": "SUITE 102",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254339",
            "telephone_number": "970-484-5437",
            "fax_number": "970-484-5436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MIDPOINT DR",
            "address_2": "SUITE 102",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254339",
            "telephone_number": "970-484-5437",
            "fax_number": "970-484-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-11",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "MILMONT",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "307-772-1793"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KidsFirst Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 1, 2016; 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.