| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2405 Mullins Ave, Alamosa, Colorado |
| Authorized Official Name and Position | Darrell Gilbert Jackson (OWNER) |
| Authorized Official Contact | 7195895272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2405 Mullins Ave Alamosa CO 81101 Ph: (719) 589-5272 | 2405 Mullins Ave Alamosa CO 81101 Ph: (719) 589-5272 |
| NPI Number | 1588657795 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 08/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588657795 | NPI | - | NPPES |
| 08230064 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8293 (Colorado) | Primary |
Avalon Dentistry P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 815 West Ave, Alamosa, CO 81101 Phone: 719-589-4771 | |
Welch Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 206 Crestone Ave, Alamosa, CO 81101 Phone: 719-589-6629 Fax: 719-589-8410 | |
Sweet Tooth Dental, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 Victoria Ave, Alamosa, CO 81101 Phone: 719-937-2227 | |
Alamosa Family Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2415 Mullins Ave Unit 5, Alamosa, CO 81101 Phone: 719-991-2101 | |
Yah Ortho Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 216 Victoria Ave, Alamosa, CO 81101 Phone: 719-937-2227 |