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General NPI Number Information
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NPI Number | 1104449818
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Entity Type | Organization
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Legal Business Name | PIONEER DENTAL SERVICES, PLLC
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 340 JUSTIN AVE STE 102
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City | PLATTEVILLE
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State | CO
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Zip | 80651-7819
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Country | US
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Telephone | 970-785-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 479 JOSEPHINE ST
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City | DENVER
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State | CO
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Zip | 80206-4208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN MARSHALL
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Credential | DDS
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Telephone | 352-279-0376
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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 |
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License Number State |
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