| Greeley Dental, Professional Llc | |
|
3766 W 10th St Ste A Greeley CO 80634-1823 | |
| (970) 304-1273 | |
| (970) 304-6979 |
| Full Name | Greeley Dental, Professional Llc |
|---|---|
| Speciality | Dentist |
| Location | 3766 W 10th St, Greeley, Colorado |
| Authorized Official Name and Position | Andrey Kondratenko (DENTIST) |
| Authorized Official Contact | 9703041273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Greeley Dental, Professional Llc 3766 W 10th St Ste A Greeley CO 80634-1823 Ph: (970) 304-1273 | Greeley Dental, Professional Llc 3766 W 10th St Ste A Greeley CO 80634-1823 Ph: (970) 304-1273 |
| NPI Number | 1255740577 |
|---|---|
| Provider Enumeration Date | 08/12/2014 |
| Last Update Date | 08/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255740577 | NPI | - | NPPES |
| 31476538 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 9341 (Colorado) | Primary |
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