Fun At The Dentist Professional Llc | |
2525 N 8th St Ste 105 Grand Jct CO 81501-8808 | |
(970) 255-1111 | |
(970) 241-5555 |
Full Name | Fun At The Dentist Professional Llc |
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Speciality | Dentist - Pediatric Dentistry |
Location | 2525 N 8th St Ste 105, Grand Jct, Colorado |
Authorized Official Name and Position | Mary Jeanett White (OFFICE MANAGER) |
Authorized Official Contact | 9702551111 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Fun At The Dentist Professional Llc 2525 N 8th St Ste 105 Grand Jct CO 81501-8808 Ph: (970) 255-1111 | Fun At The Dentist Professional Llc 2525 N 8th St Ste 105 Grand Jct CO 81501-8808 Ph: (970) 255-1111 |
NPI Number | 1316541733 |
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Provider Enumeration Date | 11/25/2020 |
Last Update Date | 11/25/2020 |
Identifier | Type | State | Issuer |
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1316541733 | NPI | - | NPPES |
16037375 | Medicaid | CO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |