Healthcare Provider Details

I. General information

NPI: 1932258233
Provider Name (Legal Business Name): ALLAN HYMAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 BOOKCLIFF AVE UNIT 202
GRAND JUNCTION CO
81501-8159
US

IV. Provider business mailing address

1190 BOOKCLIFF AVE UNIT 202
GRAND JUNCTION CO
81501-8159
US

V. Phone/Fax

Practice location:
  • Phone: 970-245-8810
  • Fax: 970-245-2705
Mailing address:
  • Phone: 970-245-8810
  • Fax: 970-245-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104643
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: