| Ryan T Anderson Ddc Pc | |
|
13 E 4th St. La Junta CO 81050 | |
| (719) 384-9442 | |
| Not Available |
| Full Name | Ryan T Anderson Ddc Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 13 E 4th St., La Junta, Colorado |
| Authorized Official Name and Position | Ryan Anderson (GENERAL DENTIST) |
| Authorized Official Contact | 7193849442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan T Anderson Ddc Pc 13 E 4th St La Junta CO 81050-3601 Ph: (719) 384-9442 | Ryan T Anderson Ddc Pc 13 E 4th St. La Junta CO 81050 Ph: (719) 384-9442 |
| NPI Number | 1952774465 |
|---|---|
| Provider Enumeration Date | 11/05/2015 |
| Last Update Date | 02/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952774465 | NPI | - | NPPES |
| 02061620 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 00202659 (Colorado) | Primary |
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