| NPI | 1205358017 |
|---|---|
| Doing Business As | COLLEGE AVE MODERN DENTAL |
| Entity Type | Organization |
| Authorized Contact | SCOTT FREDERICK Owner/Dentist 970-233-8933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 10115) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |