# PUEBLO WEST DENTAL, PROF.LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pueblo West Neighborhood Dental and Implants
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891456711
- **Authorized official:** TAYLOR ROSS DDS (MEMBER)
- **Authorized official phone:** (303) 263-3902

## Contact information

- **Practice address:** 120 S STARDUST DR, PUEBLO WEST, CO 81007-1631
- **Practice address phone:** (719) 547-4474
- **Mailing address:** 120 S STARDUST DR, PUEBLO WEST, CO 81007-1631

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/03/2022
- **Last updated:** 01/03/2022