Healthcare Provider Details

I. General information

NPI: 1881319317
Provider Name (Legal Business Name): DDS VANTAGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 GRAND AVE
GLENWOOD SPRINGS CO
81601-3501
US

IV. Provider business mailing address

2412 PATTERSON RD STE 7
GRAND JUNCTION CO
81505-1259
US

V. Phone/Fax

Practice location:
  • Phone: 970-230-9934
  • Fax:
Mailing address:
  • Phone: 970-243-2025
  • Fax: 970-243-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN POOVEY
Title or Position: PARTNER
Credential: DMD
Phone: 970-201-9590