Individual
SAMANTHA RAE DIDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
245 VINE AVE, LAS ANIMAS, CO 81054
(719) 456-2653
Mailing address
1119 W 11TH ST, LA JUNTA, CO 81050-2608
(972) 672-4468
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
202930
CO
Other
Enumeration date
09/01/2016
Last updated
06/05/2018
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