Organization
JUST FOR GRINS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE PACHECO (BUSINESS MANAGER)
(719) 392-5111
Entity
Organization
Contact information
Practice address
6436 S US HIGHWAY 85-87, SUITE C, FOUNTAIN, CO 80817
(719) 392-5111
(719) 392-4143
Mailing address
6436 S US HIGHWAY 85-87, SUITE C, FOUNTAIN, CO 80817-1005
(719) 392-5111
(719) 392-4143
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8170
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31100058
—
CO
Enumeration date
08/16/2007
Last updated
01/15/2026
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