Organization
PREMIER DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
685 CITADEL DR E, SUITE 302, COLORADO SPRINGS, CO 80909-5314
(719) 596-1011
(719) 596-6748
Mailing address
PO BOX 970084, OREM, UT 84097-0084
(801) 691-1701
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104471
CO
1223G0001X
General Practice Dentistry
6035
CO
1223G0001X
General Practice Dentistry
6716
CO
Other
Enumeration date
01/23/2007
Last updated
07/02/2021
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