Organization
BLUE MESA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA ANNE NICHOLSON (OFFICE MANAGER)
(720) 489-9800
Entity
Organization
Contact information
Practice address
8100 S QUEBEC ST, ST A 15, ENGLEWOOD, CO 80112
(720) 489-9800
(720) 489-9813
Mailing address
8100 S QUEBEC ST, ST A 15, ENGLEWOOD, CO 80112
(720) 489-9800
(720) 489-9813
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6619
CO
122300000X
Dentist
Primary
9054
CO
Other
Enumeration date
01/19/2007
Last updated
08/22/2020
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