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Organization

PUEBLO DENTAL CENTER OF PUEBLO

Active
Parent organization
PRESTIGE DENTAL CENTERS LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PRESTIGE DENTAL CENTERS LLC
Authorized official
TINA COMER (OFFICE MANAGER)
(719) 582-4222
Entity
Organization

Contact information

Practice address
1700 N SALEM AVE, SUITE B, PUEBLO, CO 81001-2846
(719) 582-4222
(719) 597-7507
Mailing address
3208 N ACADEMY BLVD, SUITE 110, COLORADO SPRINGS, CO 80917-5161
(719) 597-3700
(719) 597-7507

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7989
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
CO
Enumeration date
09/05/2013
Last updated
09/05/2013
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