Organization
RIDGE STREET DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEILL CURTIS SLACK D.D.S. (OWNER)
(970) 453-1996
Entity
Organization
Contact information
Practice address
213 S. RIDGE ST, BRECKENRIDGE, CO 80424
(970) 453-1996
Mailing address
PO BOX 5620, BRECKENRIDGE, CO 80424-5620
(970) 453-1996
(970) 453-1171
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5521
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223
GENERAL DENTIST
CO
Enumeration date
09/06/2006
Last updated
08/22/2020
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