| Pueblo Pediatric Dentistry | |
|
1640 W Fortino Blvd Pueblo CO 81008 | |
| (719) 543-7123 | |
| Not Available |
| Full Name | Pueblo Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1640 W Fortino Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Olga Jasina (PRESIDENT) |
| Authorized Official Contact | 2146800443 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Pediatric Dentistry 139 Worth St Iselin NJ 08830-2458 Ph: (214) 680-0443 | Pueblo Pediatric Dentistry 1640 W Fortino Blvd Pueblo CO 81008 Ph: (719) 543-7123 |
| NPI Number | 1649624362 |
|---|---|
| Provider Enumeration Date | 04/19/2016 |
| Last Update Date | 04/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649624362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DEN.00202786 (Colorado) | Primary |
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