| Radiant Dental Health | |
|
313 W Drake Rd Fort Collins CO 80526-2846 | |
| (970) 422-1122 | |
| (970) 425-1243 |
| Full Name | Radiant Dental Health |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 313 W Drake Rd, Fort Collins, Colorado |
| Authorized Official Name and Position | Nathaniel Boone Caldon (OWNER/ DENTIST) |
| Authorized Official Contact | 9704221122 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiant Dental Health 313 W Drake Rd Fort Collins CO 80526-2846 Ph: (970) 422-1122 | Radiant Dental Health 313 W Drake Rd Fort Collins CO 80526-2846 Ph: (970) 422-1122 |
| NPI Number | 1063041374 |
|---|---|
| Provider Enumeration Date | 04/07/2020 |
| Last Update Date | 04/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063041374 | NPI | - | NPPES |
| 1598950669 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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