Organization Name: | BLUE YONDER DENTAL CARE |
NPI Number: | 1023491297 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEVEN LANE COMBS (OWNER) |
Mailing Address: | 1745 Shea Center Dr #486 Highlands Ranch |
State: | CO US |
Postal Code: | 801291537 |
Phone Number: | 7208361127 |
Fax Number: | 7208363322 |
NPI Enumeration Date: | 07/06/2015 |
NPI Last Update Date: | 07/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DEN.00006022 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |