| Canyon Crest Family Dental & Aesthetics | |
|
332 S Orchard Springs Dr Ste 110 Pueblo West CO 81007-6154 | |
| (719) 924-8858 | |
| Not Available |
| Full Name | Canyon Crest Family Dental & Aesthetics |
|---|---|
| Speciality | Dentist |
| Location | 332 S Orchard Springs Dr Ste 110, Pueblo West, Colorado |
| Authorized Official Name and Position | Travis Lyle Boyer (OWNER) |
| Authorized Official Contact | 7199248858 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Crest Family Dental & Aesthetics 332 S Orchard Springs Dr Ste 110 Pueblo West CO 81007-6154 Ph: (719) 924-8858 | Canyon Crest Family Dental & Aesthetics 332 S Orchard Springs Dr Ste 110 Pueblo West CO 81007-6154 Ph: (719) 924-8858 |
| NPI Number | 1255835187 |
|---|---|
| Provider Enumeration Date | 03/23/2018 |
| Last Update Date | 03/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255835187 | NPI | - | NPPES |
| 07178506 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 00202790 (* (Not Available)) | Primary |
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