Green Mountain LLC

NPI #1851778641 in Idaho Springs, Colorado

Provider Information

NPI Number
1851778641
Entity Type
Organization
Organization Name
Green Mountain LLC
Primary Specialty
Clinic/Center - Dental
Enumeration Date
Apr 30, 2015
Last Updated
Apr 30, 2015

Practice Location

Address
1625 MINER STREET
ZIP Code
80452
Phone
(716) 472-5745

Authorized Official

Name
DR. JOSHUA W RICKS, DDS
Title
OWNER/DENTIST
Phone
(716) 472-5745

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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