Organization
FOUR CORNERS SMILES 4 KIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. J RYAN MICKELSON DDS. (OWNER)
(970) 247-0202
Entity
Organization
Contact information
Practice address
1135 S CAMINO DEL RIO, STE. 210, DURANGO, CO 81303-6831
(970) 247-0202
(970) 247-0404
Mailing address
1135 S CAMINO DEL RIO, STE. 210, DURANGO, CO 81303-6831
(970) 247-0202
(970) 247-0404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8630
CO
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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