Organization
HEADWATERS DENTAL MANAGEMENT
Active
Other names
Pueblo West Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADY SEFCIK (DDS/OWNER)
(719) 547-4474
Entity
Organization
Contact information
Practice address
120 S STARDUST DR, PUEBLO WEST, CO 81007-1631
(719) 547-4474
(719) 547-4710
Mailing address
120 S STARDUST DR, PUEBLO WEST, CO 81007-1631
(719) 547-4474
(719) 547-4710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00202298
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80780580
—
CO
Enumeration date
04/13/2016
Last updated
04/13/2016
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