Organization
SSUN HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED ANTHONY LACOURT DDS (CHIEF DENTAL OFFICER)
(414) 303-7484
Entity
Organization
Contact information
Practice address
550 SAINT MICHAELS DR STE 2, SANTA FE, NM 87505-7604
(505) 216-2364
Mailing address
10940 S PARKER RD, PARKER, CO 80134-7440
(515) 371-3782
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/18/2020
Last updated
01/18/2020
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