Organization
SAN JUAN DENTAL ANESTHESIA SERVICES, PROFESSIONAL LLC
Active
Organization
SAN JUAN DENTAL ANESTHESIA SERVICES, PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAYLOR CLARK D.D.S. (OWNER)
(970) 247-4848
Entity
Organization
Contact information
Practice address
835 E 2ND AVE, SUITE 270, DURANGO, CO 81301-5475
(970) 247-4848
(877) 888-7642
Mailing address
835 E 2ND AVE, SUITE 270, DURANGO, CO 81301-5475
(970) 247-4848
(877) 888-7642
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
201890
CO
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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