Organization
EAGLE ORTHODONTICS, PC
Active
Other names
Eagle Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN RODEN-JOHNSON DDS, MS (OWNER)
(512) 923-2041
Entity
Organization
Contact information
Practice address
011 EAGLE PARK DR., EAGLE, CO 81631
(970) 328-1075
Mailing address
PO BOX 3538, EAGLE, CO 81631-3538
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22109
TX
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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