MEDICARE: GRAND JUNCTION ORAL SURGERY ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		CO

General Provider Information

NPI Number	:	1114008224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND JUNCTION ORAL SURGERY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	2532 PATTERSON ROAD
Second Line	:	SUITE 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1098
Country	:	US
Telephone Number	:	970-241-2820
Fax Number	:	970-248-9553

Provider Business Practice Location Address
First Line	:	2532 PATTERSON RD
Second Line	:	SUITE 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1098
Country	:	US
Telephone Number	:	970-241-2820
Fax Number	:	970-248-9553

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH EUGENE PERINO
Credential	:	DDS
Telephone Number	:	970-241-2820

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/04/2010

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