Provider Demographics
NPI:1477386571
Name:NORTHERN COLORADO TONGUE AND LIP TIE CLINIC LLC
Entity type:Organization
Organization Name:NORTHERN COLORADO TONGUE AND LIP TIE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:970-672-7525
Mailing Address - Street 1:260 E HORSETOOTH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3124
Mailing Address - Country:US
Mailing Address - Phone:970-672-7525
Mailing Address - Fax:
Practice Address - Street 1:260 E HORSETOOTH RD STE 130
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3124
Practice Address - Country:US
Practice Address - Phone:970-672-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty