Organization
SAN JUAN DENTAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CARLSON DDS (OWNER)
(970) 565-4448
Entity
Organization
Contact information
Practice address
115 N BEECH ST, CORTEZ, CO 81321-3207
(970) 565-4448
(970) 565-7211
Mailing address
115 N BEECH ST, CORTEZ, CO 81321-3207
(970) 565-4448
(970) 565-7211
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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