Organization
EDEN DENTAL PUEBLO PC
Active
Other names
Implant & Periodontic Specialists of Pueblo
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ROBERT HERRERA (BUSINESS MANAGER)
(760) 978-8527
Entity
Organization
Contact information
Practice address
2041 PEPPER LN, PUEBLO, CO 81005-3276
(719) 696-9009
Mailing address
2041 PEPPER LN, PUEBLO, CO 81005-3276
(719) 696-9009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
11/12/2020
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