| Elmer A. Villalon, Dmd, Llc | |
|
1225 North Main Street #207 Pueblo CO 81003 | |
| (719) 542-7844 | |
| (719) 542-7870 |
| Full Name | Elmer A. Villalon, Dmd, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1225 North Main Street, Pueblo, Colorado |
| Authorized Official Name and Position | Elmer A. Villalon (OWNER) |
| Authorized Official Contact | 7195427844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elmer A. Villalon, Dmd, Llc 1225 N Main St Ste 207 Pueblo CO 81003-2857 Ph: (719) 542-7844 | Elmer A. Villalon, Dmd, Llc 1225 North Main Street #207 Pueblo CO 81003 Ph: (719) 542-7844 |
| NPI Number | 1023654241 |
|---|---|
| Provider Enumeration Date | 11/22/2019 |
| Last Update Date | 11/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023654241 | NPI | - | NPPES |
| 02059525 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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