| Cottonwood Dental Center | |
|
2405 Mullins Ave Alamosa CO 81101 | |
| (719) 589-5272 | |
| (719) 589-5300 |
| Full Name | Cottonwood Dental Center |
|---|---|
| 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 |
|---|---|
| Cottonwood Dental Center 2405 Mullins Ave Alamosa CO 81101 Ph: (719) 589-5272 | Cottonwood Dental Center 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 |
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