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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