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General NPI Number Information
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NPI Number | 1205028941
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Entity Type | Organization
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Legal Business Name | JUST FOR GRINS LLC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 6436 S US HIGHWAY 85-87 SUITE C
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City | FOUNTAIN
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State | CO
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Zip | 80817
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Country | US
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Telephone | 719-392-5111
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Fax | 719-392-4143
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Provider Business Mailing Address
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Address Line | 6436 S US HIGHWAY 85-87 SUITE C
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City | FOUNTAIN
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State | CO
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Zip | 80817-1005
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Country | US
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Telephone | 719-392-5111
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Fax | 719-392-4143
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DOMINIQUE PACHECO
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Credential |
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Telephone | 719-392-5111
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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 | 8170
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License Number State | CO
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