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General NPI Number Information
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NPI Number | 1023491297
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Entity Type | Organization
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Legal Business Name | BLUE YONDER DENTAL CARE
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 9205 E. 159TH AVE
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City | BRIGHTON
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State | CO
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Zip | 80602-8676
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Country | US
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Telephone | 720-836-1127
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Fax | 720-836-3322
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Provider Business Mailing Address
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Address Line | 9205 E. 159TH AVE
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City | BRIGHTON
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State | CO
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Zip | 80602-8676
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Country | US
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Telephone | 720-836-1127
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Fax | 720-836-3322
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN LANE COMBS
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Credential | DDS
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Telephone | 308-631-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DEN.00006022
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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