Healthcare Provider Details

I. General information

NPI: 1770833287
Provider Name (Legal Business Name): AMBER LYNN GRACEY R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N 6TH ST
GRAND JUNCTION CO
81501
US

IV. Provider business mailing address

2552 PATTERSON RD
GRAND JUNCTION CO
81505-1423
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-1782
  • Fax: 970-692-8301
Mailing address:
  • Phone: 970-241-1313
  • Fax: 970-241-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number906574
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: