| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 011 Eagle Park Dr., Eagle, Colorado |
| Authorized Official Name and Position | Dustin Roden-johnson (OWNER) |
| Authorized Official Contact | 5129232041 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3538 Eagle CO 81631-3538 Ph: () - | 011 Eagle Park Dr. Eagle CO 81631 Ph: (970) 328-1075 |
| NPI Number | 1710428883 |
|---|---|
| Provider Enumeration Date | 03/09/2017 |
| Last Update Date | 03/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710428883 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 22109 (Texas) | Primary |
Smiles 4 Kids 111 Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Chamber Ave, Eagle, CO 81631 Phone: 970-249-8595 | |
All Kids Dental Pediatrics And Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1185 Capitol St. #101, Eagle, CO 81631 Phone: 970-328-9500 Fax: 970-928-7467 | |
Image Dental Eagle Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 56 Market St, Suite #5, Eagle, CO 81631 Phone: 970-328-1116 Fax: 970-328-0524 | |
Dental Arts Of Eagle Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 West 6th Street, Eagle, CO 81631 Phone: 970-328-6347 Fax: 970-328-6375 | |
Eagle Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1185 Capitol St, Suite 104, Eagle, CO 81631 Phone: 970-328-5268 Fax: 970-328-5267 |