Healthcare Provider Details

I. General information

NPI: 1174702880
Provider Name (Legal Business Name): JUSTIN C. BLEY D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 61ST AVE SUITE 102
GREELEY CO
80634-7997
US

IV. Provider business mailing address

1707 61ST AVE SUITE 102
GREELEY CO
80634-7997
US

V. Phone/Fax

Practice location:
  • Phone: 970-506-0350
  • Fax: 970-506-0352
Mailing address:
  • Phone: 970-506-0350
  • Fax: 970-506-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number9050
License Number StateCO

VIII. Authorized Official

Name: DR. JUSTIN C BLEY
Title or Position: OWNER
Credential: D.M.D.
Phone: 970-506-0350