Provider Demographics
NPI:1922564202
Name:RELAXATION DENTAL SPECIALTIES SALIDA
Entity Type:Organization
Organization Name:RELAXATION DENTAL SPECIALTIES SALIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-539-3145
Mailing Address - Street 1:1222 C ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2723
Mailing Address - Country:US
Mailing Address - Phone:719-539-3145
Mailing Address - Fax:
Practice Address - Street 1:1222 C ST
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2723
Practice Address - Country:US
Practice Address - Phone:719-539-3145
Practice Address - Fax:719-631-0659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental