Healthcare Provider Details

I. General information

NPI: 1295403186
Provider Name (Legal Business Name): DDS VANTAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 PATTERSON RD
GRAND JUNCTION CO
81505-1243
US

IV. Provider business mailing address

2412 PATTERSON RD
GRAND JUNCTION CO
81505-1243
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-2026
  • Fax:
Mailing address:
  • Phone: 970-243-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN POOVEY
Title or Position: DDS
Credential: DMD
Phone: 970-243-2026