Organization
MOUNTAIN DENTAL ANESTHESIA LLC
Active
Parent organization
MOUNTAIN DENTAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MOUNTAIN DENTAL LLC
Authorized official
JOHN RUSSELL YANCEY DDS (DENTIST ANESTHESIOLOGIST)
(317) 459-0738
Entity
Organization
Contact information
Practice address
11001 W 120TH AVE STE 400, BROOMFIELD, CO 80021-3493
(317) 459-0738
Mailing address
7787 W 106TH AVE, WESTMINSTER, CO 80021-3951
(317) 459-0738
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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