Organization
GREELEY DENTAL, PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREY KONDRATENKO DDS (DENTIST)
(970) 304-1273
Entity
Organization
Contact information
Practice address
3766 W 10TH ST, STE A, GREELEY, CO 80634-1823
(970) 304-1273
(970) 304-6979
Mailing address
3766 W 10TH ST, STE A, GREELEY, CO 80634-1823
(970) 304-1273
(970) 304-6979
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9341
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31476538
—
CO
Enumeration date
08/12/2014
Last updated
08/12/2014
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