| Four Corners Smiles 4 Kids, Inc. | |
|
1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 | |
| (970) 247-0202 | |
| (970) 247-0404 |
| Full Name | Four Corners Smiles 4 Kids, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1135 S Camino Del Rio, Durango, Colorado |
| Authorized Official Name and Position | J Ryan Mickelson (OWNER) |
| Authorized Official Contact | 9702470202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Corners Smiles 4 Kids, Inc. 1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 Ph: (970) 247-0202 | Four Corners Smiles 4 Kids, Inc. 1135 S Camino Del Rio Ste. 210 Durango CO 81303-6831 Ph: (970) 247-0202 |
| NPI Number | 1225364607 |
|---|---|
| Provider Enumeration Date | 10/20/2009 |
| Last Update Date | 10/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225364607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8630 (Colorado) | Primary |
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Twin Buttes Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 County Road 250, Durango, CO 81301 Phone: 970-247-0682 | |
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