Healthcare Provider Details

I. General information

NPI: 1932175346
Provider Name (Legal Business Name): COMMUNITY DENTAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MERCHANT DR
MONTROSE CO
81401-3015
US

IV. Provider business mailing address

87 MERCHANT DR
MONTROSE CO
81401-3015
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-8896
  • Fax: 970-240-3095
Mailing address:
  • Phone: 970-252-8896
  • Fax: 970-240-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateCO

VIII. Authorized Official

Name: MELANIE HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-252-8896