Provider Demographics
NPI:1689371015
Name:MINI MINERS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MINI MINERS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-229-2125
Mailing Address - Street 1:61 ERIE PKWY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2592
Mailing Address - Country:US
Mailing Address - Phone:303-500-3202
Mailing Address - Fax:
Practice Address - Street 1:61 ERIE PKWY UNIT 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2592
Practice Address - Country:US
Practice Address - Phone:303-500-3202
Practice Address - Fax:303-732-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty