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General NPI Number Information
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NPI Number | 1629297304
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Entity Type | Organization
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Legal Business Name | GRAND DENTAL P.C.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1035 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3427
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Country | US
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Telephone | 970-243-8580
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Fax | 970-242-4331
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Provider Business Mailing Address
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Address Line | 1035 GRAND AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-3427
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Country | US
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Telephone | 970-243-8580
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Fax | 970-242-4331
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. BRETT CLIFTON
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Credential | D.D.S.
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Telephone | 970-243-8580
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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 | DEN104620
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License Number State | CO
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