| NPI | 1184162513 |
|---|---|
| Doing Business As | FOUNTAIN DENTAL CENTER, LLC |
| Entity Type | Organization |
| Authorized Contact | SCOTT FREDERICK Owner/Doctor 719-382-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2017-02-06 |