FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY (NPI# 1104162452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104162452 |
| Entity Type | Organization |
| Organization Name | FOUR CORNERS ORAL AND MAXILLIOFACIAL SURGERY |
| Practice Address |
72 Suttle St S# E Durango CO 81303-6829 |
| Practice Telephone | 9703855432 |
| Practice Fax Number | 9703855077 |
| Mailing Telephone | 9703855432 |
| Mailing Fax Number | 9703855077 |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2012-12-13 |
| Authorized Official Name | DR. MICHAEL WALTER JOHNSON (PRESIDENT) |
| Authorized Official Telephone | 9703855432 |
| Authorized Official Credential | M.D,DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
C36335 | CO | Ambulatory Health Care Facilities |
| Street Address |
72 SUTTLE ST S# E |
| City | DURANGO |
| State | CO |
| Zip Code | 81303-6829 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467442608 | Deborah Brill Meyers | Nurse Practitioner | 72 Suttle St, Suite C, Durango, CO 81303-6829 | 2005-10-27 |
| 1033484670 | Scott Michael Japhet | Massage Therapist | 72 Suttle St, Ste B, Durango, CO 81303-6829 | 2012-03-15 |
| 1811914344 | Michael Walter Johnson | Dentist | 72 Suttle St, S# E, Durango, CO 81303-6829 | 2006-07-17 |
| 1215904040 | Durango Dialysis Center LLC | Clinic/Center | 72 Suttle St, Ste D, Durango, CO 81303-6829 | 2006-03-01 |
| 1245212323 | Mason O Miner Dds LLC | Dentist | 72 Suttle St, Ste H, Durango, CO 81303 | 2005-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548870603 | Durango Surgery Center LLC | Clinic/Center | 1266 Escalante, Suite 101, Durango, CO 81303 | 2020-08-04 |
| 1659891489 | Sarah Raeghan Dessel | Behavioral Analyst | 2432 County Road 220, Durango, CO 81303 | 2017-06-22 |
| 1336546076 | Aerocare Holdings, Inc. | Durable Medical Equipment & Medical Supplies | 208 Parker Ave Ste C, Durango, CO 81303 | 2014-11-24 |
| 1235549361 | Brooke Hastings Cheatham | Family Medicine | 1305 Escalente Drive, Unit 205, Durango, CO 81303 | 2014-04-29 |
| 1346596855 | Kristi Deanne Stump | Registered Nurse | 281 Sawyer Drive, Durango, CO 81303 | 2012-08-02 |
| 1356643696 | Jonathan Stein Mitchell | Social Worker | 466 S. Skylane Dr., Open Sky Wilderness Therapy, Durango, CO 81303 | 2010-11-18 |
| 1295979771 | Gregory Albert Martin | Counselor | 466 South Skylane Drive, Durango, CO 81303 | 2009-04-28 |
| 1700054772 | Southwest Alternative Medical, Inc. | Family Medicine | 523-a South Camino Del Rio, Durango, CO 81303 | 2008-02-13 |
| 1316069073 | Jeffrey Yaskin | Physical Therapist | 327 S Camino Del Rio Unit 11b, Durango, CO 81303 | 2007-04-04 |
| 1023170479 | Daniel J Mcclure | Chiropractor | 523 -a S Camino Del Rio, Durango, CO 81303 | 2006-12-14 |
| Find all providers in zip 81303 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043774979 | John A Rothchild Dds PC | Clinic/Center | 175 Mercado St Ste 115, Durango, CO 81301-7318 | 2019-01-24 |
| 1447763107 | Four Corners Dentures | Clinic/Center | 2323 W 2nd Ave Ste E, Durango, CO 81301-4646 | 2017-11-15 |
| 1508173162 | A Smile By Design | Clinic/Center | 3057 Main Ave, Durango, CO 81301-4244 | 2010-09-02 |
| 1669548319 | Wilson Family Dentistry PC | Clinic/Center | 102 Half 18th St, Durango, CO 81301 | 2006-11-27 |
| 1730101726 | San Juan Basin Health Department | Clinic/Center | 701 Camino Del Rio, Southwest Smile Makers, Durango, CO 81301 | 2006-07-25 |
| 1225433170 | Taylor M. Clark, D.d.s., Professional LLC | Clinic/Center | 835 E 2nd Ave, Suite 270, Durango, CO 81301-5475 | 2014-11-04 |
| 1457799116 | Vaughn A Johnson Dds Ms PC | Clinic/Center | 801 Florida Rd, Durango, CO 81301-4780 | 2013-06-04 |
| 1568625853 | Ryan W. Whitman Family & Cosmetic Dentistry, Pllc | Clinic/Center | 1165 S Camino Del Rio Ste 300, Durango, CO 81303-6824 | 2008-07-07 |
| 1669642690 | Ronald T. Owens Dds PC | Clinic/Center | 1304 Main Ave, Durango, CO 81301-5139 | 2008-03-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528669074 | Red House | Clinic/Center | 440 S Lincoln Ave Ste B10, Steamboat Springs, CO 80487-8935 | 2020-11-02 |
| 1881294387 | Scott Holm Dmd Pllc | Clinic/Center | 685 Citadel Dr E Ste 200b, Colorado Springs, CO 80909-5315 | 2020-10-26 |
| 1205435013 | Kids In Need of Dentistry | Clinic/Center | 4201 E 72nd Ave Unit D, Commerce City, CO 80022-1578 | 2020-10-22 |
| 1619576428 | Kids In Need of Dentistry | Clinic/Center | 925 N Lincoln St Ste B, Denver, CO 80203-2784 | 2020-10-22 |
| 1477151173 | Professional Dental Care of New Mexico | Clinic/Center | 10233 S Parker Rd Ste 107, Parker, CO 80134-9314 | 2020-10-14 |
| 1023615556 | Vida Orthodontics | Clinic/Center | 19551 Hess Rd Unit 110, Parker, CO 80134-3446 | 2020-10-07 |
| 1417554668 | Turner, Pllc | Clinic/Center | 5361 S Gray St, Denver, CO 80123-5110 | 2020-10-01 |
| 1316553860 | Willow Creek Perfect Teeth PC | Clinic/Center | 8150 S Quebec St Ste C, Centennial, CO 80112-3186 | 2020-09-21 |
| 1326653841 | Nic - Denver, Pllc | Clinic/Center | 8000 E Prentice Ave Ste A3, Greenwood Village, CO 80111-2725 | 2020-09-11 |
| 1568075489 | Open and Affordable Dental Cs North Pllc | Clinic/Center | 6375 Lehman Dr Ste 200, Colorado Springs, CO 80918-1427 | 2020-08-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.