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General NPI Number Information
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NPI Number | 1104462878
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Entity Type | Organization
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Legal Business Name | REDLANDS MESA FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 2412 PATTERSON RD STE 1
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1259
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Country | US
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Telephone | 970-543-1393
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Fax | 970-549-0262
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Provider Business Mailing Address
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Address Line | 2412 PATTERSON RD STE 1
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1259
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Country | US
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Telephone | 970-543-1393
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Fax | 970-549-0262
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIE BENJAMIN
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Credential | DDS
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Telephone | 970-549-1393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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