Organization
PAGOSA KIDS FAMILYDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLER ANTHONY MANN D.D.S. (DENTIST)
(970) 264-0554
Entity
Organization
Contact information
Practice address
46 EATON DR STE 1, PAGOSA SPRINGS, CO 81147-8228
(970) 264-0554
Mailing address
46 EATON DR STE 1, PAGOSA SPRINGS, CO 81147-8228
(970) 264-0554
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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