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General NPI Number Information
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NPI Number | 1417223041
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Entity Type | Organization
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Legal Business Name | A KIDZ DENTIST
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1560 PINE GROVE ROAD SUITE C
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80477
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Country | US
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Telephone | 970-879-7976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 882830
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City | STEAMBOAT SPRINGS
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State | CO
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Zip | 80488-2830
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Country | US
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Telephone | 970-879-7976
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LISA SALYER
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Credential |
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Telephone | 970-879-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7535
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License Number State | CO
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