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Organization
FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY
Active
Organization
FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WALTER JOHNSON M.D,DDS (PRESIDENT)
(970) 385-5432
Entity
Organization
Contact information
Practice address
72 SUTTLE ST, S# E, DURANGO, CO 81303-6829
(970) 385-5432
(970) 385-5077
Mailing address
72 SUTTLE ST, S# E, DURANGO, CO 81303-6829
(970) 385-5432
(970) 385-5077
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
C36335
CO
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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