Organization
ON-SITE DENTIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON PECHEK DDS (DIRECTOR OF DENTISTRY)
(719) 821-2237
Entity
Organization
Contact information
Practice address
10734 E BERRY AVE, ENGLEWOOD, CO 80111-3972
(719) 821-2237
Mailing address
PO BOX 3449, GREENWOOD VILLAGE, CO 80155-3449
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9163
CO
Other
Enumeration date
09/06/2017
Last updated
10/10/2017
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