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
- City
- Idaho Springs
- State
- Colorado
- 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 - Dental — Dental |
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