Organization
EAGLE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER COLLIS BEAL (OWNER)
(970) 328-5268
Entity
Organization
Contact information
Practice address
1185 CAPITOL ST, SUITE 104, EAGLE, CO 81631-5000
(970) 328-5268
(970) 328-5267
Mailing address
PO BOX 5499, EAGLE, CO 81631-5499
(970) 328-5268
(970) 328-5267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9677
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225288129
INDIVIDUAL NPI
CO
Enumeration date
12/05/2011
Last updated
02/26/2013
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