Provider Demographics
NPI:1730433889
Name:PLATTEVILLE FAMILY DENTISTRY
Entity type:Organization
Organization Name:PLATTEVILLE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-590-6205
Mailing Address - Street 1:417 BLUE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8893
Mailing Address - Country:US
Mailing Address - Phone:970-590-6205
Mailing Address - Fax:
Practice Address - Street 1:340 JUSTIN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PLATTEVILLE
Practice Address - State:CO
Practice Address - Zip Code:80651-7800
Practice Address - Country:US
Practice Address - Phone:970-590-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10088261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental