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120 S Stardust Dr Pueblo West CO 81007-1631 | |
| (719) 547-4474 | |
| (719) 547-4710 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 120 S Stardust Dr, Pueblo West, Colorado |
| Authorized Official Name and Position | Brady Sefcik (DDS/OWNER) |
| Authorized Official Contact | 7195474474 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
120 S Stardust Dr Pueblo West CO 81007-1631 Ph: (719) 547-4474 | 120 S Stardust Dr Pueblo West CO 81007-1631 Ph: (719) 547-4474 |
| NPI Number | 1255795464 |
|---|---|
| Provider Enumeration Date | 04/13/2016 |
| Last Update Date | 04/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255795464 | NPI | - | NPPES |
| 80780580 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 00202298 (Colorado) | Primary |
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Rock Canyon Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 332 S Orchard Springs Dr Ste 110, Pueblo West, CO 81007 Phone: 719-924-8858 | |
Dental Specialists Of Southern Colorado, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 332 S Orchard Springs Dr Ste 110, Pueblo West, CO 81007 Phone: 719-569-5959 Fax: 719-300-5259 | |