Organization
AJ CANON DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN JESSE LEE DMD (OWNER)
(650) 722-0005
Entity
Organization
Contact information
Practice address
1227 S 9TH ST, CANON CITY, CO 81212-4211
(719) 285-4784
(719) 345-4120
Mailing address
1227 S 9TH ST, CANON CITY, CO 81212-4211
(719) 285-4784
(719) 345-4120
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10543
CO
Other
Enumeration date
03/03/2015
Last updated
03/03/2015
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