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General NPI Number Information
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NPI Number | 1083071047
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Entity Type | Organization
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Legal Business Name | JMJ III
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 491 FOREST EDGE RD
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City | WOODLAND PARK
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State | CO
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Zip | 80863-2499
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Country | US
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Telephone | 719-687-6366
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Fax | 719-687-6388
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Provider Business Mailing Address
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Address Line | 491 FOREST EDGE RD
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City | WOODLAND PARK
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State | CO
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Zip | 80863-2499
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Country | US
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Telephone | 719-687-6366
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Fax | 719-687-6388
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RUTH G BISHOP
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Credential |
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Telephone | 719-687-6366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5676
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License Number State | CO
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