Provider Demographics
NPI:1114008224
Name:GRAND JUNCTION ORAL SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:GRAND JUNCTION ORAL SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PERINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-241-2820
Mailing Address - Street 1:2532 PATTERSON ROAD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1098
Mailing Address - Country:US
Mailing Address - Phone:970-241-2820
Mailing Address - Fax:970-248-9553
Practice Address - Street 1:2532 PATTERSON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1098
Practice Address - Country:US
Practice Address - Phone:970-241-2820
Practice Address - Fax:970-248-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty