Provider Demographics
NPI:1083071047
Name:JMJ III
Entity Type:Organization
Organization Name:JMJ III
Other - Org Name:FOREST EDGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-687-6366
Mailing Address - Street 1:491 FOREST EDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-2499
Mailing Address - Country:US
Mailing Address - Phone:719-687-6366
Mailing Address - Fax:719-687-6388
Practice Address - Street 1:491 FOREST EDGE RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-2499
Practice Address - Country:US
Practice Address - Phone:719-687-6366
Practice Address - Fax:719-687-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO56761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty