Organization
SAN JUAN DENTAL HYGIENE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADELEINE BESERRA (RDH, MGR)
(970) 264-9436
Entity
Organization
Contact information
Practice address
101 PAGOSA STREET, PAGOSA SPRINGS, CO 81147
(970) 264-9436
Mailing address
PO BOX 2336, PAGOSA SPRINGS, CO 81147-2336
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
660
CO
Other
Enumeration date
07/10/2008
Last updated
07/10/2008
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