Organization
SOUTH POWERS DENTAL PROF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLY A COOK (MANAGER)
(719) 574-8922
Entity
Organization
Contact information
Practice address
1580 SPACE CENTER DRIVE, SUITE 107, COLORADO SPRINGS, CO 80915
(719) 574-8922
(719) 574-8924
Mailing address
1580 SPACE CENTER DR, SUITE 107, COLORADO SPRINGS, CO 80915-2445
(719) 574-8922
(719) 574-8924
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10001
CO
122300000X
Dentist
Primary
9312
CO
Other
Enumeration date
11/17/2009
Last updated
08/09/2017
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