Organization
MAIN STREET DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB BEUS DMD (OWNER)
(719) 275-3255
Entity
Organization
Contact information
Practice address
330 MAIN ST, CANON CITY, CO 81212-3732
(719) 275-3255
(719) 275-3863
Mailing address
330 MAIN ST, CANON CITY, CO 81212-3732
(719) 275-3255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/25/2015
Last updated
02/09/2023
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