| Professional Dental Care Of Southern Colorado I Pllc | |
|
123 W 2nd St Portales NM 88130-6201 | |
| (575) 268-0007 | |
| Not Available |
| Full Name | Professional Dental Care Of Southern Colorado I Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 123 W 2nd St, Portales, New Mexico |
| Authorized Official Name and Position | Cary Lacouture (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3035215701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Care Of Southern Colorado I Pllc 10233 S Parker Rd Ste 107 Parker CO 80134-9314 Ph: (303) 521-5701 | Professional Dental Care Of Southern Colorado I Pllc 123 W 2nd St Portales NM 88130-6201 Ph: (575) 268-0007 |
| NPI Number | 1033701313 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033701313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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