Eden Dental Pueblo PC
Dentist, Periodontics in Pueblo, CO. Organization (NPI-2).
NPI number1154970366
StatusActive
Last updated in NPPESNov 12, 2020
Details
- NPI
- 1154970366
- Entity type
- Organization (NPI-2)
- Legal business name
- Eden Dental Pueblo PC
- Organization subpart
- No
- Enumeration date
- Sep 10, 2019
- Certification date
- Nov 12, 2020
- Last updated
- Nov 12, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | – | – | Yes |
| 1223G0001X | Dentist, General Practice | – | – |
Other names
- Implant & Periodontic Specialists Of Pueblo (Doing Business As)
Practice location
2041 Pepper LnPueblo, CO 81005-3276
Phone 719-696-9009
Mailing address
2041 Pepper LnPueblo, CO 81005-3276
Phone 719-696-9009
Authorized official
Michael Robert Herrera
Business Manager
7609788527
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