Advantage Dental Group
Dentist in Pueblo, CO. Organization (NPI-2).
NPI number1205276128
StatusActive
Last updated in NPPESJun 25, 2013
Details
- NPI
- 1205276128
- Entity type
- Organization (NPI-2)
- Legal business name
- Advantage Dental Group
- Organization subpart
- No
- Enumeration date
- Jun 25, 2013
- Last updated
- Jun 25, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 105682 | CO | Yes |
Practice location
1800 Fortino Blvd Unit 1Pueblo, CO 81008-1891
Phone 719-545-1400 · Fax 719-545-5153
Mailing address
1800 Fortino Blvd Unit 1Pueblo, CO 81008-1891
Phone 719-545-1400 · Fax 719-545-5153
Authorized official
Eric L. Berry
Owner
7195451400
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