| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 11/25/2020 |
| Last Update Date | 11/25/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316541733 | NPI | - | NPPES |
| 16037375 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |