# MOUNTAIN STREAM DENTAL CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Timberland Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679204317
- **Authorized official:** DR. LEILA MACARIO DMD (GENERAL DENTIST)
- **Authorized official phone:** (954) 599-9530

## Contact information

- **Practice address:** 791 W KELLY RD, WOODLAND PARK, CO 80863-3014
- **Practice address phone:** (719) 687-9011
- **Mailing address:** 791 W KELLY RD, WOODLAND PARK, CO 80863-3014
- **Mailing address phone:** (719) 687-9011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/23/2022
- **Last updated:** 06/23/2022