=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548866023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YES DENTAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2020
-----------------------------------------------------
Last Update Date | 12/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2530 N 8TH ST STE 2530N8TH
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-8857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-241-4937
-----------------------------------------------------
Fax | 970-241-3605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2530 N 8TH ST STE 2530N8TH
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-8857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-241-4937
-----------------------------------------------------
Fax | 970-241-3605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL MANAGER
-----------------------------------------------------
Name | LISA P TOBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-241-4937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------