| Lake City Dental Clinic | |
|
700 N Henson St Lake City CO 81235-5134 | |
| (970) 944-2331 | |
| (970) 944-2320 |
| Full Name | Lake City Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 700 N Henson St, Lake City, Colorado |
| Authorized Official Name and Position | Jessica Whiddon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9709442331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake City Dental Clinic Po Box 999 Lake City CO 81235-0999 Ph: (970) 944-2331 | Lake City Dental Clinic 700 N Henson St Lake City CO 81235-5134 Ph: (970) 944-2331 |
| NPI Number | 1376143081 |
|---|---|
| Provider Enumeration Date | 10/30/2020 |
| Last Update Date | 10/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376143081 | NPI | - | NPPES |
| 9000141620 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Lake City Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 700 North Henson St, Lake City, CO 81235 Phone: 970-944-2331 Fax: 970-944-2320 | |
Lake City Area Medical Center Dental Clinic Medicare: Medicare Enrolled Practice Location: 700 N Henson, Lake City, CO 81235 Phone: 970-944-2331 Fax: 970-944-2320 |