Provider Demographics
NPI:1598475907
Name:PEDIATRIC DENTAL SPECIALISTS OF MONTROSE, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS OF MONTROSE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-639-9551
Mailing Address - Street 1:2466 HWY 6 AND 50 STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-5500
Mailing Address - Country:US
Mailing Address - Phone:970-639-9551
Mailing Address - Fax:
Practice Address - Street 1:1435 HAWK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6440
Practice Address - Country:US
Practice Address - Phone:970-639-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty