Healthcare Provider Details

I. General information

NPI: 1649112574
Provider Name (Legal Business Name): BUENA BOCA MOBILE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 PALMER PARK BLVD
COLORADO SPRINGS CO
80909-2710
US

IV. Provider business mailing address

4130 PALMER PARK BLVD
COLORADO SPRINGS CO
80909-2710
US

V. Phone/Fax

Practice location:
  • Phone: 719-645-4791
  • Fax:
Mailing address:
  • Phone: 719-645-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: NANCY LORENA ARGUELLO
Title or Position: DENTAL HYGIENIST
Credential: RDH, BAS
Phone: 719-367-7752