Organization
FOUR CORNERS FAMILY DENTAL-CO, LLC
Active
Parent organization
FOUR CORNERS FAMILY DENTAL, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUR CORNERS FAMILY DENTAL, LLC
Authorized official
JENNIFER MANN (OFFICE MANAGER)
(505) 320-2942
Entity
Organization
Contact information
Practice address
308 N PAGOSA ST, PAGOSA SPRINGS, CO 81147
(970) 507-1300
Mailing address
3501 N BUTLER AVE STE 104, FARMINGTON, NM 87401
(505) 320-2942
(505) 325-9707
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.0000111
CO
Other
Enumeration date
05/19/2015
Last updated
05/19/2015
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