Provider Demographics
NPI:1073359733
Name:JUST FOR GRINS LLC
Entity type:Organization
Organization Name:JUST FOR GRINS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-375-0690
Mailing Address - Street 1:11876 STAPLETON DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8438
Mailing Address - Country:US
Mailing Address - Phone:719-375-0690
Mailing Address - Fax:
Practice Address - Street 1:11876 STAPLETON DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-8438
Practice Address - Country:US
Practice Address - Phone:719-375-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUST FOR GRINS DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-02
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty