# PAONIA DENTAL PC

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

## Provider details

- **NPI number:** 1790112605
- **Authorized official:** FALON WAISATH DMD (PRESIDENT)
- **Authorized official phone:** (970) 527-4853

## Contact information

- **Practice address:** 402 2ND ST, PAONIA, CO 81428
- **Practice address phone:** (970) 527-4853
- **Practice address fax:** (970) 527-4855
- **Mailing address:** PO BOX 21, PAONIA, CO 81428-0021
- **Mailing address phone:** (970) 527-4853
- **Mailing address fax:** (970) 527-4855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 202094 | CO | Yes |

## Other

- **Enumeration date:** 10/09/2013
- **Last updated:** 10/09/2013