Provider Demographics
NPI:1487820247
Name:DENTAL ASSOCIATES OF THE SOUTHWEST
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-0113
Mailing Address - Street 1:801 FLORIDA RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4780
Mailing Address - Country:US
Mailing Address - Phone:970-259-0113
Mailing Address - Fax:
Practice Address - Street 1:801 FLORIDA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4780
Practice Address - Country:US
Practice Address - Phone:970-259-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty