Provider Demographics
NPI:1437327582
Name:PUEBLO COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:PUEBLO COMMUNITY COLLEGE
Other - Org Name:DENTAL ASSISTING CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-549-3379
Mailing Address - Street 1:900 W ORMAN AVE
Mailing Address - Street 2:MT 130
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1430
Mailing Address - Country:US
Mailing Address - Phone:719-549-3379
Mailing Address - Fax:719-549-3389
Practice Address - Street 1:900 W ORMAN AVE
Practice Address - Street 2:MT 130
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1430
Practice Address - Country:US
Practice Address - Phone:719-549-3379
Practice Address - Fax:719-549-3389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUEBLO COMMUNITY COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty