Jenny C Alas, D.M.D.
Individual provider Active NPI Dentist · Pueblo, CO
NPI 1245758168 · NPPES record last updated Aug 30, 2017
Key facts
- NPI
- 1245758168
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 00203164 (CO)
- Practice address
- 2603 Vinewood Lane
Pueblo, CO 81005 - Phone
- (719) 564-6464
- Fax
- (719) 564-1888
- NPI assigned
- Aug 30, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00203164 | CO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 00203164 | CO | Yes |
Addresses
Primary practice location
2603 Vinewood Lane
Pueblo, CO 81005
Mailing address
2603 Vinewood Lane
Pueblo, CO 81005
Phone (719) 564-6464
Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.