| Pdr Greeley Pllc | |
|
2003 46th Ave Greeley CO 80634-3250 | |
| (970) 330-4600 | |
| (970) 330-4612 |
| Full Name | Pdr Greeley Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2003 46th Ave, Greeley, Colorado |
| Authorized Official Name and Position | Keith Van Tassell (DENTIST) |
| Authorized Official Contact | 9703304600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pdr Greeley Pllc 2003 46th Ave Greeley CO 80634-3250 Ph: (970) 330-4600 | Pdr Greeley Pllc 2003 46th Ave Greeley CO 80634-3250 Ph: (970) 330-4600 |
| NPI Number | 1992261820 |
|---|---|
| Provider Enumeration Date | 02/15/2019 |
| Last Update Date | 02/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992261820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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