College Ave Modern Dental Practice, LLC
NPI 1205358017ActiveOrganization· Dentist· Fort Collins, CO
Dentist in Fort Collins, Colorado, registered in NPPES in July 2017. The authorized official on file is Scott Frederick, DDS, Owner/Dentist.
Overview
| NPI | 1205358017 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 13, 2017 |
| Last updated in NPPES | Jul 21, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 10115 | CO |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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