Provider Demographics
NPI:1043815129
Name:YES DENTAL INC
Entity Type:Organization
Organization Name:YES DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-4937
Mailing Address - Street 1:2530 N 8TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8856
Mailing Address - Country:US
Mailing Address - Phone:970-241-4937
Mailing Address - Fax:970-241-3605
Practice Address - Street 1:25 STAFFORD LN STE 2
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3442
Practice Address - Country:US
Practice Address - Phone:970-241-4937
Practice Address - Fax:970-241-3605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1285980532Medicaid