Organization
FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WALTER JOHNSON M.D,DDS (PRESIDENT)
(970) 385-5432
Entity
Organization
Contact information
Practice address
72 SUTTLE ST, S# E, DURANGO, CO 81303-6829
(970) 385-5432
(970) 385-5077
Mailing address
72 SUTTLE ST, S# E, DURANGO, CO 81303-6829
(970) 385-5432
(970) 385-5077
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
C36335
CO
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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