Provider Demographics
NPI:1730107079
Name:FORD, JAMES P (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:FORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:P
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:101 CANARY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1543
Mailing Address - Country:US
Mailing Address - Phone:970-260-5966
Mailing Address - Fax:970-257-7273
Practice Address - Street 1:127 CANARY LN
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-1543
Practice Address - Country:US
Practice Address - Phone:970-260-5966
Practice Address - Fax:970-257-7273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02007862Medicaid