Organization
FUN AT THE DENTIST PROFESSIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN R DEAN DDS, MS (PRESIDENT)
(970) 255-1111
Entity
Organization
Contact information
Practice address
2525 N 8TH ST, SUITE 105, GRAND JUNCTION, CO 81501-8845
(970) 255-1111
(970) 241-5555
Mailing address
2525 N 8TH ST, SUITE 105, GRAND JUNCTION, CO 81501-8845
(970) 255-1111
(970) 241-5555
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
104423
CO
Other
Enumeration date
04/06/2012
Last updated
04/06/2012
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