| My Local Colorado Dental Practice, Llc | |
|
8085 Fountain Mesa Rd Fountain CO 80817-1591 | |
| (719) 382-5500 | |
| Not Available |
| Full Name | My Local Colorado Dental Practice, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8085 Fountain Mesa Rd, Fountain, Colorado |
| Authorized Official Name and Position | Michelle Johnson (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 5093158338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| My Local Colorado Dental Practice, Llc 8085 Fountain Mesa Rd Fountain CO 80817-1591 Ph: () - | My Local Colorado Dental Practice, Llc 8085 Fountain Mesa Rd Fountain CO 80817-1591 Ph: (719) 382-5500 |
| NPI Number | 1811541402 |
|---|---|
| Provider Enumeration Date | 07/31/2019 |
| Last Update Date | 07/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811541402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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