Provider Demographics
NPI:1700322534
Name:SAYERS DENTAL PC
Entity type:Organization
Organization Name:SAYERS DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-322-8162
Mailing Address - Street 1:643 SOUTH PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005
Mailing Address - Country:US
Mailing Address - Phone:719-561-8170
Mailing Address - Fax:719-561-8198
Practice Address - Street 1:643 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1540
Practice Address - Country:US
Practice Address - Phone:719-561-8170
Practice Address - Fax:719-561-8198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAYERS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9813122300000X
CO54841223G0001X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty