Provider Demographics
NPI:1629297304
Name:GRAND DENTAL P.C.
Entity Type:Organization
Organization Name:GRAND DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-243-8580
Mailing Address - Street 1:1035 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3427
Mailing Address - Country:US
Mailing Address - Phone:970-243-8580
Mailing Address - Fax:970-242-4331
Practice Address - Street 1:1035 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3427
Practice Address - Country:US
Practice Address - Phone:970-243-8580
Practice Address - Fax:970-242-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN104620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty