Provider Demographics
NPI:1932360211
Name:SAUNDERS DENTURE CLINIC
Entity Type:Organization
Organization Name:SAUNDERS DENTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOWLETT-LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-544-6787
Mailing Address - Street 1:2047 COLUMBIA LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3279
Mailing Address - Country:US
Mailing Address - Phone:719-544-6787
Mailing Address - Fax:719-564-1301
Practice Address - Street 1:2047 COLUMBIA LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3279
Practice Address - Country:US
Practice Address - Phone:719-544-6787
Practice Address - Fax:719-564-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04400284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1598856296Medicaid