Keith Allen Van Tassell, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9197 Issued in CO

Practice address

2001 S Shields St BLDG a
Suite 2
Fort Collins, CO 80526-1827

Phone

(970) 484-4104

Fax

(970) 484-5245

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366585408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S SHIELDS ST BLDG A",
            "address_2": "SUITE 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261827",
            "telephone_number": "970-484-4104",
            "fax_number": "970-484-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S SHIELDS ST BLDG A",
            "address_2": "SUITE 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805261827",
            "telephone_number": "970-484-4104",
            "fax_number": "970-484-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN TASSELL",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "9197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Value in Prevention of Colorado PLLC
• Melanee Lavon Van Ee-Mortensen, AU.D.
• Erin L Van Horne, RN, BSN
• Danielle Van Nest
• Gina Van Ort, CAS, BSW
• Carly Rianne Van Tine, OTR/L
• Curt E Van Tress, APN
• Loretta Ann Van Wyhe
• Laura Vanarsdale
• Amber Marie Vance, NP

• Pediatric Dentistry in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.