Provider Demographics
NPI:1154786879
Name:GRAND VALLEY DENTAL SLEEP ASSOCIATES,LLC
Entity type:Organization
Organization Name:GRAND VALLEY DENTAL SLEEP ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:LYBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-858-9511
Mailing Address - Street 1:551 KOKOPELLI BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-6305
Mailing Address - Country:US
Mailing Address - Phone:970-858-9511
Mailing Address - Fax:970-858-8520
Practice Address - Street 1:551 KOKOPELLI BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6305
Practice Address - Country:US
Practice Address - Phone:970-858-9511
Practice Address - Fax:970-858-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty