Organization
PROFESSIONAL DENTAL HYGIENE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA JEAN VILLARREAL (MANAGER)
(719) 486-8285
Entity
Organization
Contact information
Practice address
130 W 5TH ST, SUITE 118 AND 121, LEADVILLE, CO 80461-3510
(719) 486-8285
Mailing address
PO BOX 572, LEADVILLE, CO 80461-0572
(719) 486-8285
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DH-905202
CO
Other
Enumeration date
03/19/2010
Last updated
03/19/2010
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