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General NPI Number Information
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NPI Number | 1841757028
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Entity Type | Organization
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Legal Business Name | ELEVATED DENTAL
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 101 E COLORADO AVE SUITE 202
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City | TELLURIDE
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State | CO
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Zip | 81435
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Country | US
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Telephone | 970-728-3665
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Fax | 970-728-6589
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Provider Business Mailing Address
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Address Line | PO BOX 2439
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City | TELLURIDE
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State | CO
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Zip | 81435-2439
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Country | US
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Telephone | 970-728-3665
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Fax | 970-728-6589
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Authorized Official
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Title or Position | FRONT OFFICE ADMINISTRATOR
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Name | ASHLEY DENTON
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Credential |
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Telephone | 970-728-3665
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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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