Provider Demographics
NPI:1689616088
Name:DARREL R. BLEHM D.D.S., P.C.
Entity Type:Organization
Organization Name:DARREL R. BLEHM D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-245-0785
Mailing Address - Street 1:1212 BOOKCLIFF AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8162
Mailing Address - Country:US
Mailing Address - Phone:970-245-0785
Mailing Address - Fax:970-254-9830
Practice Address - Street 1:1212 BOOKCLIFF AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8162
Practice Address - Country:US
Practice Address - Phone:970-245-0785
Practice Address - Fax:970-254-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty