Four Corners Smiles 4 Kids, Inc. | |
1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 | |
(970) 247-0202 | |
(970) 247-0404 |
Full Name | Four Corners Smiles 4 Kids, Inc. |
---|---|
Speciality | Dentist - General Practice |
Location | 1135 S Camino Del Rio, Durango, Colorado |
Authorized Official Name and Position | J Ryan Mickelson (OWNER) |
Authorized Official Contact | 9702470202 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Four Corners Smiles 4 Kids, Inc. 1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 Ph: (970) 247-0202 | Four Corners Smiles 4 Kids, Inc. 1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 Ph: (970) 247-0202 |
NPI Number | 1225364607 |
---|---|
Provider Enumeration Date | 10/20/2009 |
Last Update Date | 10/20/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225364607 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 8630 (Colorado) | Primary |
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