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Organization

ORCHARD SPRINGS DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROL RIEG (MANAGER)
(719) 276-0117
Entity
Organization

Contact information

Practice address
410 MACON AVE, CANON CITY, CO 81212-3225
(719) 276-0117
(719) 276-0653
Mailing address
410 MACON ST, CANON CITY, CO 81212
(719) 276-0117
(719) 276-0653

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
105973
CO
122300000X
Dentist
106275
CO
122300000X
Dentist
Primary
8336
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
17258871
CO
05
88834042
CO
Enumeration date
04/19/2007
Last updated
08/22/2020
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