| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 440 Erie Pkwy, Erie, Colorado |
| Authorized Official Name and Position | Jessica Britt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408426 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
440 Erie Pkwy Erie CO 80516 Ph: (217) 540-5100 | 440 Erie Pkwy Erie CO 80516 Ph: (217) 540-5100 |
| NPI Number | 1255843975 |
|---|---|
| Provider Enumeration Date | 11/03/2017 |
| Last Update Date | 11/03/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255843975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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