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General NPI Number Information
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NPI Number | 1346065182
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Entity Type | Organization
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Legal Business Name | COLORADO MOUNTAIN COLLEGE
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 150 MILLER RANCH RD
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City | EDWARDS
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State | CO
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Zip | 81632-6420
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Country | US
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Telephone | 970-569-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MILLER RANCH RD
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City | EDWARDS
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State | CO
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Zip | 81632-6420
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Country | US
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Telephone | 970-569-2950
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Fax |
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Authorized Official
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Title or Position | CLINICAL & ADMINISTRATIVE COORDINAT
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Name | REBECCA ACOSTA
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Credential |
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Telephone | 970-569-2950
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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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