NPIMap

Organization Active NPI

San Juan Basin Health Department

  • Dental Clinic/Center
  • Durango, CO
National Provider Identifier
1730101726
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SAN JUAN BASIN HEALTH DEPARTMENT
Practice address
701 Camino del Rio
Southwest Smile Makers
Durango, CO 81301
Phone
(970) 385-4480
Fax
(970) 247-7882
NPI assigned
Jul 25, 2006
Last updated
Sep 22, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN JUAN BASIN HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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

Authorized official

Name
Ms. Liane Jollon, RN
Title
Executive Director
Phone
(970) 247-5702

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

701 Camino del Rio
Southwest Smile Makers
Durango, CO 81301

Mailing address

281 Sawyer Dr.
Durango, CO 81303-3409
Phone (970) 247-5702

Other identifiers 1

IdentifierTypeStateIssuer
96635339MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
San Juan Basin Health Department5 organizations share this tax ID, including this one
Part of
San Juan Basin Health Department

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

701 Camino del Rio
Durango, CO 81301
Phone (970) 247-3261

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1730101726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 SAWYER DR.",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813033409",
            "telephone_number": "970-247-5702",
            "fax_number": "970-247-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CAMINO DEL RIO",
            "address_2": "SOUTHWEST SMILE MAKERS",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "81301",
            "telephone_number": "970-385-4480",
            "fax_number": "970-247-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN BASIN HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN JUAN BASIN HEALTH DEPARTMENT",
        "enumeration_date": "2006-07-25",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "JOLLON",
        "authorized_official_first_name": "LIANE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-247-5702",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96635339",
            "state": "CO"
        }
    ],
    "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 Sep 22, 2014; 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.