| Green Mountain Llc | |
|
1625 Miner Street Idaho Springs CO 80452 | |
| (716) 472-5745 | |
| Not Available |
| Full Name | Green Mountain Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1625 Miner Street, Idaho Springs, Colorado |
| Authorized Official Name and Position | Joshua W Ricks (OWNER/DENTIST) |
| Authorized Official Contact | 7164725745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Mountain Llc Po Box 277 Idaho Springs CO 80452-0277 Ph: (716) 472-5745 | Green Mountain Llc 1625 Miner Street Idaho Springs CO 80452 Ph: (716) 472-5745 |
| NPI Number | 1851778641 |
|---|---|
| Provider Enumeration Date | 04/30/2015 |
| Last Update Date | 04/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851778641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 00202483 (Colorado) | Primary |
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