Provider Demographics
NPI:1992894562
Name:HARGLEROAD, JENNIFER K (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:HARGLEROAD
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:2105 BIGHORN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3575
Mailing Address - Country:US
Mailing Address - Phone:970-493-2254
Mailing Address - Fax:970-493-0940
Practice Address - Street 1:2105 BIGHORN RD STE 202
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3575
Practice Address - Country:US
Practice Address - Phone:970-493-2254
Practice Address - Fax:970-493-0940
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO83651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025261500Medicaid
CO78907811Medicaid
CO54182336Medicaid