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General NPI Number Information
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NPI Number | 1528855830
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Entity Type | Organization
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Legal Business Name | PAGOSA SPRINGS FAMILY DENTAL LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2363 EAGLE DR UNIT A
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-9058
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Country | US
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Telephone | 970-528-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 245 PINES CLUB PL
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-9304
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Country | US
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Telephone | 970-528-3384
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Fax | 970-507-9898
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN J NYLUND
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Credential | DDS
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Telephone | 970-528-3384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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