Provider Demographics
NPI:1962861104
Name:GRIN & BARRETT ORTHODONTICS
Entity Type:Organization
Organization Name:GRIN & BARRETT ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:720-529-5777
Mailing Address - Street 1:6650 S VINE ST
Mailing Address - Street 2:L-80
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2735
Mailing Address - Country:US
Mailing Address - Phone:720-529-5777
Mailing Address - Fax:
Practice Address - Street 1:6650 S VINE ST
Practice Address - Street 2:L-80
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2735
Practice Address - Country:US
Practice Address - Phone:720-529-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO001052751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02052751Medicaid