Iconic Dental INC
NPI #1497103691 in Walsenburg, Colorado
Provider Information
- NPI Number
- 1497103691
- Entity Type
- Organization
- Organization Name
- Iconic Dental INC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- May 27, 2016
- Last Updated
- May 27, 2016
Practice Location
- Address
- 624 MAIN ST
- City
- Walsenburg
- State
- Colorado
- ZIP Code
- 81089-2136
- Phone
- (719) 695-1004
Authorized Official
- Name
- TACI COOPER
- Title
- OFFICE MANAGER
- Phone
- (719) 241-3140
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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