Four Corners Family Dental-Co, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DEN.0000111 Issued in CO

Legal business name

FOUR CORNERS FAMILY DENTAL-CO, LLC

Practice address

308 N Pagosa St
Pagosa Springs, CO 81147

Phone

(970) 507-1300

NPI assigned

May 19, 2015

Organization subpart

Yes

Parent organization

FOUR CORNERS FAMILY DENTAL, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Mann

Title

Office Manager

Phone

(505) 320-2942

Specialties & licenses 1

Addresses

Part of

Four Corners Family Dental LLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431993600000",
    "number": "1003295478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE STE 104",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-320-2942",
            "fax_number": "505-325-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N PAGOSA ST",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "81147",
            "telephone_number": "970-507-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS FAMILY DENTAL-CO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUR CORNERS FAMILY DENTAL, LLC",
        "enumeration_date": "2015-05-19",
        "last_updated": "2015-05-19",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-320-2942"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.0000111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Flemmings, MD
• Patricia L Flynn, RDH
• Erik W Foss
• Stacey L Foss, LAC
• Four Corners Eye Clinic, PC
• Erin Lynn Frankel Jeansonne, D.C.
• Tara L Frie, R.N.
• Pamela Marie Gembica
• Barton Elgin Giessel, M.D.
• Daniel Glover

• Dentist in Pagosa Springs, CO
• Providers in Pagosa Springs, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.