San Juan Dental Clinic PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SAN JUAN DENTAL CLINIC PC

Practice address

115 N Beech St
Cortez, CO 81321-3207

Phone

(970) 565-4448

Fax

(970) 565-7211

NPI assigned

Sep 29, 2015

Last updated

Sep 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth Carlson, DDSNPI 1336147313

Title

Owner

Phone

(970) 565-4448

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenneth Raymond Carlson, D.D.S.

  • General Practice Dentistry
  • Cortez, CO
  • NPI 1336147313
  Authorized official Same address or phone

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1487024865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N BEECH ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213207",
            "telephone_number": "970-565-4448",
            "fax_number": "970-565-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N BEECH ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213207",
            "telephone_number": "970-565-4448",
            "fax_number": "970-565-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN DENTAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-29",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-565-4448",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Charles Ruggera, M.D.
• Rural Physicians Group - Pannu PLLC
• Sacred Path Behavioral Health, LLC
• Safeway Inc (Safeway Pharmacy #1892)
• Dan Sage
• San Juan Sentry, LLC (Cortez Cab)
• Brandon Dwayne Sanchez, PA-C
• Sand Canyon Therapy LLC
• Christian Augustine Sanders, LCSW, LMSW, LADAC
• Jennifer Lee Sandoval, RPH

• General Practice Dentistry in Cortez, CO
• Providers in Cortez, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.