Provider Demographics
NPI:1306087622
Name:TELLURIDE DENTAL P.C.
Entity type:Organization
Organization Name:TELLURIDE DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-728-4336
Mailing Address - Street 1:PO BOX 3644
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3644
Mailing Address - Country:US
Mailing Address - Phone:970-728-4336
Mailing Address - Fax:970-369-4386
Practice Address - Street 1:126 WEST COLORADO AVE.
Practice Address - Street 2:SUITE 203
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-4336
Practice Address - Fax:970-369-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty