Organization
COLORADO WEST ENDODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL WAYNE NORTHUP DDS (CO OWNER)
(970) 242-9088
Entity
Organization
Contact information
Practice address
1190 BOOKCLIFF AVE, #204, GRAND JUNCTION, CO 81501
(970) 242-9088
(970) 257-0255
Mailing address
1190 BOOKCLIFF AVE, #204, GRAND JUNCTION, CO 81501
(970) 242-9088
(970) 257-0255
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7116
CO
1223E0200X
Endodontics
7175
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
822910
UNITED CONCORDIA INS
—
Enumeration date
09/26/2006
Last updated
08/22/2020
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