Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 2930 11th Ave, Evans, Colorado |
Authorized Official Name and Position | Cathy Wolff (CFO) |
Authorized Official Contact | 9703462546 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2930 11th Ave Ste B Evans CO 80620-1011 Ph: (970) 353-9403 | 2930 11th Ave Evans CO 80620-1011 Ph: (970) 353-9403 |
NPI Number | 1184466492 |
---|---|
Provider Enumeration Date | 06/07/2024 |
Last Update Date | 07/03/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184466492 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |