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General NPI Number Information
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NPI Number | 1790593176
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Entity Type | Organization
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Legal Business Name | M & D DENTAL LLC
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 933 SELL AVE UNIT A
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City | CANON CITY
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State | CO
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Zip | 81212-4955
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Country | US
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Telephone | 719-430-9888
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Fax | 719-430-9889
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Provider Business Mailing Address
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Address Line | 933 SELL AVE UNIT A
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City | CANON CITY
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State | CO
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Zip | 81212-4955
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Country | US
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Telephone | 719-430-9888
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Fax | 719-430-9889
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DAWN REID
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Credential |
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Telephone | 719-430-8888
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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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