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Organization

TAOS COUNTY DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MICHELLE OLSON (REGIONAL HUMAN RESOURCE DIRECTOR)
(719) 344-5693
Entity
Organization

Contact information

Practice address
105 PASEO DEL CANON W STE B, TAOS, NM 87571-6943
(575) 758-3205
(575) 758-3756
Mailing address
105 PASEO DEL CANON W STE B, TAOS, NM 87571-6943
(575) 758-3205
(575) 758-3756

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
261QD0000X
Dental Clinic/Center
Primary
202298
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3889262
CO
Enumeration date
09/20/2017
Last updated
07/21/2022
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