Organization
ICONIC DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TACI COOPER (OFFICE MANAGER)
(719) 241-3140
Entity
Organization
Contact information
Practice address
624 MAIN ST, WALSENBURG, CO 81089-2136
(719) 695-1004
(719) 695-1006
Mailing address
624 MAIN ST, WALSENBURG, CO 81089-2136
(719) 695-1004
(719) 695-1006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
CO
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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