Organization
FUN AT THE DENTIST PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JEANETT WHITE (OFFICE MANAGER)
(970) 255-1111
Entity
Organization
Contact information
Practice address
2525 N 8TH ST STE 105, GRAND JCT, CO 81501-8808
(970) 255-1111
(970) 241-5555
Mailing address
2525 N 8TH ST STE 105, GRAND JCT, CO 81501-8808
(970) 255-1111
(970) 241-5555
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16037375
—
CO
Enumeration date
11/25/2020
Last updated
11/25/2020
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