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Organization
PROFESSIONAL DENTAL CARE PLLC
Active
Organization
PROFESSIONAL DENTAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED ANTHONY LACOURT DDS (CHIEF DENTAL OFFICER)
(414) 303-7484
Entity
Organization
Contact information
Practice address
550 SAINT MICHAELS DR STE 2, SANTA FE, NM 87505-7604
(505) 216-2364
Mailing address
10940 S PARKER RD, PARKER, CO 80134-7440
(515) 371-3782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/18/2020
Last updated
01/18/2020
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