Provider Demographics
NPI:1760694459
Name:MESA ORTHODONTICS
Entity Type:Organization
Organization Name:MESA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-245-8810
Mailing Address - Street 1:1190 BOOKCLIFF AVE #202
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8150
Mailing Address - Country:US
Mailing Address - Phone:970-245-8810
Mailing Address - Fax:
Practice Address - Street 1:1190 BOOKCLIFF AVE UNIT 202
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8159
Practice Address - Country:US
Practice Address - Phone:970-245-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty