Provider Demographics
NPI:1194358762
Name:RATON FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:RATON FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-717-8637
Mailing Address - Street 1:132 N COMMERCIAL ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2655
Mailing Address - Country:US
Mailing Address - Phone:801-717-8637
Mailing Address - Fax:
Practice Address - Street 1:1100 S 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2326
Practice Address - Country:US
Practice Address - Phone:801-717-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental