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1215 N 15th St Canon City CO 81212-4620 | |
| (719) 275-5933 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1215 N 15th St, Canon City, Colorado |
| Authorized Official Name and Position | Kyu Hyuk Jung (PRESIDENT/DENTIST) |
| Authorized Official Contact | 7192755933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1215 N 15th St Canon City CO 81212-4620 Ph: () - | 1215 N 15th St Canon City CO 81212-4620 Ph: (719) 275-5933 |
| NPI Number | 1518747765 |
|---|---|
| Provider Enumeration Date | 10/04/2023 |
| Last Update Date | 11/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518747765 | NPI | - | NPPES |
| 1396261251 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Smile Doctors Of Colorado, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 610 Yale Pl, Canon City, CO 81212 Phone: 719-417-5625 | |
House Family Dental Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1227 S 9th St, Canon City, CO 81212 Phone: 719-924-8623 | |
Orchard Springs Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Macon Ave, Canon City, CO 81212 Phone: 719-276-0117 Fax: 719-276-0653 | |
Bradley J. Schluter, D.d.s. Inc. Dental Clinic Medicare: Medicare Enrolled Practice Location: 210 N 19th St, Canon City, CO 81212 Phone: 719-275-2454 |