Provider Demographics
NPI:1699389510
Name:OCOTILLO DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:OCOTILLO DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLORADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-342-7351
Mailing Address - Street 1:11259 S FRONTAGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7883
Mailing Address - Country:US
Mailing Address - Phone:928-342-7351
Mailing Address - Fax:928-569-1427
Practice Address - Street 1:11259 S FRONTAGE RD STE 103
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7883
Practice Address - Country:US
Practice Address - Phone:928-342-7351
Practice Address - Fax:928-569-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental