Divine Dermatology and Surgical Institute, Pllc

NPI #1962164269 in Longmont, Colorado

Provider Information

NPI Number: 1962164269
Entity Type: Organization
Organization Name: Divine Dermatology and Surgical Institute, Pllc
Subpart: Yes (part of a larger organization)
Parent Organization: DIVINE DERMATOLOGY AND SURGICAL INSTITUE, PLLC
Primary Specialty: Dermatology
Enumeration Date: Oct 13, 2021
Last Updated: Oct 13, 2021

Practice Location

Address: 1715 IRON HORSE DR STE 104
City: Longmont
State: Colorado
ZIP Code: 80501-9756
Phone: (970) 286-2668

Authorized Official

Name: JENNIFER MICHELLE DIVINE
Title: OWNER
Phone: (970) 286-2668

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dermatology	207N00000X	Primary

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