Healthcare Provider Details

I. General information

NPI: 1609798024
Provider Name (Legal Business Name): M&M DENTAL PARTNERSHIP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 COOLEY MESA RD UNIT D
GYPSUM CO
81637
US

IV. Provider business mailing address

PO BOX 918
GYPSUM CO
81637-0918
US

V. Phone/Fax

Practice location:
  • Phone: 970-431-6616
  • Fax: 970-431-6810
Mailing address:
  • Phone: 970-431-6616
  • Fax: 970-431-6810

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: JUSTIN MICHAEL MOSES
Title or Position: PARTNER/DENTIST
Credential:
Phone: 970-476-3991