Organization
MINERS FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SHRUM PHD (OWNER)
(505) 634-1501
Entity
Organization
Contact information
Practice address
1315 SNOWDEN STE. 4B, SILVERTON, CO 81433
(505) 634-1501
Mailing address
PO BOX 448, BLANCO, NM 87412-0448
(505) 634-1505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN.00203360
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
CO
Enumeration date
05/08/2018
Last updated
06/16/2018
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