Full Name | |
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Speciality | Dentist - General Practice |
Location | 120 North 2nd Avenue, Ault, Colorado |
Authorized Official Name and Position | Bradley William Eckhardt (OWNER) |
Authorized Official Contact | 9708342058 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1038 Ault CO 80610-1038 Ph: (970) 834-2058 | 120 North 2nd Avenue Ault CO 80610 Ph: (970) 834-2058 |
NPI Number | 1003111618 |
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Provider Enumeration Date | 01/13/2011 |
Last Update Date | 01/13/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003111618 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | DEN9157 (Colorado) | Primary |