Provider Demographics
NPI:1366957458
Name:DALE G STRIETZEL DDS
Entity type:Organization
Organization Name:DALE G STRIETZEL DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-247-3303
Mailing Address - Street 1:1911 MAIN AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5079
Mailing Address - Country:US
Mailing Address - Phone:970-247-3303
Mailing Address - Fax:
Practice Address - Street 1:1911 MAIN AVE STE 116
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5079
Practice Address - Country:US
Practice Address - Phone:970-247-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALE G STRIETZEL DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-11
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty