Provider Demographics
NPI:1518340694
Name:RUBY CANYON DENTAL GROUP, PC
Entity Type:Organization
Organization Name:RUBY CANYON DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-261-3004
Mailing Address - Street 1:2552 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1423
Mailing Address - Country:US
Mailing Address - Phone:970-241-1313
Mailing Address - Fax:970-241-5202
Practice Address - Street 1:2552 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1423
Practice Address - Country:US
Practice Address - Phone:970-241-1313
Practice Address - Fax:970-241-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty