Organization
JADE DENTAL PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG L RODRIGUEZ (ADMINSTRATOR)
(719) 633-0770
Entity
Organization
Contact information
Practice address
703 N TEJON ST STE A, COLORADO SPRINGS, CO 80903-1050
(719) 313-8666
Mailing address
703 N TEJON ST STE A, COLORADO SPRINGS, CO 80903-1050
(719) 313-8666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7157
CO
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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