Provider Demographics
NPI:1366512667
Name:SALIDA FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:SALIDA FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-539-2587
Mailing Address - Street 1:7600 W HWY 50
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201
Mailing Address - Country:US
Mailing Address - Phone:719-539-2587
Mailing Address - Fax:719-539-4169
Practice Address - Street 1:7600 W HWY 50
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201
Practice Address - Country:US
Practice Address - Phone:719-539-2587
Practice Address - Fax:719-539-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4375122300000X
CO7810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50855271Medicaid