| My Local Colorado Dental Practice, Llc | |
|
1691 Coalton Rd Superior CO 80027-4681 | |
| (720) 304-3267 | |
| Not Available |
| Full Name | My Local Colorado Dental Practice, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1691 Coalton Rd, Superior, 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 1691 Coalton Rd Superior CO 80027-4681 Ph: (720) 304-3267 | My Local Colorado Dental Practice, Llc 1691 Coalton Rd Superior CO 80027-4681 Ph: (720) 304-3267 |
| NPI Number | 1396399069 |
|---|---|
| Provider Enumeration Date | 07/30/2019 |
| Last Update Date | 07/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396399069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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