Organization
BEAR CREEK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSIE BRYAN MASTIN D.D.S. (OWNER)
(719) 633-2828
Entity
Organization
Contact information
Practice address
1430 S 21ST ST, SUITE 200, COLORADO SPRINGS, CO 80904-4225
(719) 633-2828
(719) 633-7461
Mailing address
1430 S 21ST ST, SUITE 200, COLORADO SPRINGS, CO 80904-4225
(719) 633-2828
(719) 633-7461
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7300
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992871909
INDIVIDUAL NPI
CO
Enumeration date
06/26/2015
Last updated
06/26/2015
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