NPI: 1376143081 · LAKE CITY, CO 81235 · Dental Clinic/Center · NPI assigned 10/30/2020
| Authorized Official | WHIDDON, JESSICA (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 10/30/2020 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 13 | $291.46 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $291.46 |