Organization
PAGOSA DENTAL CARE PC
Active
Organization
PAGOSA DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM THORNELL (OWNER)
(970) 731-6600
Entity
Organization
Contact information
Practice address
189 TALISMAN DR, STE E, PAGOSA SPGS, CO 81147-7916
(970) 731-6600
Mailing address
189 TALISMAN DR, STE E, PAGOSA SPGS, CO 81147-7916
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DEN00008224
CO
Other
Enumeration date
04/26/2017
Last updated
04/26/2017
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