Provider Demographics
NPI:1235546151
Name:GJ DENTAL PARTNERS PROF LLP
Entity Type:Organization
Organization Name:GJ DENTAL PARTNERS PROF LLP
Other - Org Name:COMFORT DENTAL GRAND JUNCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-255-1222
Mailing Address - Street 1:2650 NORTH AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 NORTH AVE
Practice Address - Street 2:STE. 101
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6405
Practice Address - Country:US
Practice Address - Phone:970-255-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92771223G0001X
CO97711223G0001X
CO98011223G0001X
CO101751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty