# NORTHEAST FAMILY DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154486272
- **Authorized official:** AARON C WOOD (CEO)
- **Authorized official phone:** (970) 774-6123

## Contact information

- **Practice address:** 115 SOUTH COLORADO AVE, HASTUN, CO 80731
- **Practice address phone:** (970) 774-7999
- **Practice address fax:** (970) 774-7997
- **Mailing address:** PO BOX 248, HAXTUN, CO 80731
- **Mailing address phone:** (970) 774-7999
- **Mailing address fax:** (970) 774-7997

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | CO8895 | CO | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 08/22/2020