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Individual

MR. ELIJAH FONSECA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DENTAL TECHNICIAN

Contact information

Practice address
2521 N TEJON ST REAR ALLEY, COLORADO SPRINGS, CO 80907-6836
(719) 308-9009
Mailing address
2521 N TEJON ST REAR ALLEY, COLORADO SPRINGS, CO 80907-6836
(719) 308-9009

Taxonomy

Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
R00782832
CO

Other

Enumeration date
02/23/2023
Last updated
02/23/2023
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