| Organization Name: | FOUNTAIN DENTAL CENTER P.C. |
| NPI Number: | 1922422633 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENDALL B SKINNER (OWNER) |
| Mailing Address: | 8085 Fountain Mesa Rd Fountain |
| State: | CO US |
| Postal Code: | 808171591 |
| Phone Number: | 7193825500 |
| Fax Number: | 7193820944 |
| NPI Enumeration Date: | 02/17/2014 |
| NPI Last Update Date: | 02/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 10691 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |