Professional Dental Care of Southern Colorado I Pllc
NPI #1033701313 in Portales, New Mexico
Provider Information
- NPI Number
- 1033701313
- Entity Type
- Organization
- Organization Name
- Professional Dental Care of Southern Colorado I Pllc
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- SSUN HEALTH, LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Feb 8, 2021
- Last Updated
- Feb 8, 2021
Practice Location
- Address
- 123 W 2ND ST
- City
- Portales
- State
- New Mexico
- ZIP Code
- 88130-6201
- Phone
- (575) 268-0007
Authorized Official
- Name
- CARY LACOUTURE, DDS
- Title
- CLINICAL DIRECTOR
- Phone
- (303) 521-5701
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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