Organization
NORTHEAST FAMILY DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON C WOOD (CEO)
(970) 774-6123
Entity
Organization
Contact information
Practice address
115 SOUTH COLORADO AVE, HASTUN, CO 80731
(970) 774-7999
(970) 774-7997
Mailing address
PO BOX 248, HAXTUN, CO 80731
(970) 774-7999
(970) 774-7997
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
CO8895
CO
Other
Enumeration date
12/27/2006
Last updated
08/22/2020
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