Four Corners Family Dental-Co, LLC

NPI #1003295478 in Pagosa Springs, Colorado

Provider Information

NPI Number: 1003295478
Entity Type: Organization
Organization Name: Four Corners Family Dental-Co, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: FOUR CORNERS FAMILY DENTAL, LLC
Primary Specialty: Dentist
Enumeration Date: May 19, 2015
Last Updated: May 19, 2015

Practice Location

Address: 308 N PAGOSA ST
City: Pagosa Springs
State: Colorado
ZIP Code: 81147
Phone: (970) 507-1300

Authorized Official

Name: JENNIFER MANN
Title: OFFICE MANAGER
Phone: (505) 320-2942

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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