| Ernesto Pacheco Dental Clinic | |
|
Unit 1 B At 233 Main Street Suite 2 San Luis CO 81152-0328 | |
| (719) 672-3352 | |
| (719) 672-3638 |
| Full Name | Ernesto Pacheco Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | Unit 1 B At 233 Main Street, San Luis, Colorado |
| Authorized Official Name and Position | Jania Arnoldi (PRESIDENT/CEO) |
| Authorized Official Contact | 7195895161 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ernesto Pacheco Dental Clinic 128 Market St Alamosa CO 81101-2290 Ph: (719) 587-1001 | Ernesto Pacheco Dental Clinic Unit 1 B At 233 Main Street Suite 2 San Luis CO 81152-0328 Ph: (719) 672-3352 |
| NPI Number | 1396734893 |
|---|---|
| Provider Enumeration Date | 10/18/2005 |
| Last Update Date | 04/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396734893 | NPI | - | NPPES |
| 13984772 | Medicaid | CO | |
| 480030 | Other | CO | DELTA DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Colorado) | Primary |
San Luis Health Center Dental Clinic Medicare: Medicare Enrolled Practice Location: 233 Main Street, Suite B, San Luis, CO 81152 Phone: 719-672-3352 Fax: 719-672-3638 |