NPIMap

Organization Active NPI

San Juan Dental Anesthesia Services, Professional LLC

  • Dental Anesthesiology
  • Durango, CO
National Provider Identifier
1609250810
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AnesthesiologyTaxonomy code 1223D0004X
License
201890 Issued in CO
Legal business name
SAN JUAN DENTAL ANESTHESIA SERVICES, PROFESSIONAL LLC
Practice address
835 E 2ND Ave
Suite 270
Durango, CO 81301-5475
Phone
(970) 247-4848
Fax
(877) 888-7642
NPI assigned
Jul 17, 2015
Last updated
Jul 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Authorized official

Name
Dr. Taylor Clark, D.D.S.
Title
Owner
Phone
(970) 247-4848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental AnesthesiologyGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0004X 201890 CO Primary

Addresses

Primary practice location

835 E 2ND Ave
Suite 270
Durango, CO 81301-5475

Mailing address

835 E 2ND Ave
Suite 270
Durango, CO 81301-5475
Phone (970) 247-4848

National Provider Directory

National Provider Directory

Locations

835 E 2nd Ave
Ste 270
Durango, CO 81301
Phone (970) 247-4848

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437091200000",
    "number": "1609250810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 E 2ND AVE",
            "address_2": "SUITE 270",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015475",
            "telephone_number": "970-247-4848",
            "fax_number": "877-888-7642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 E 2ND AVE",
            "address_2": "SUITE 270",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015475",
            "telephone_number": "970-247-4848",
            "fax_number": "877-888-7642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN DENTAL ANESTHESIA SERVICES, PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-247-4848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "CO",
            "license": "201890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.