Provider Demographics
NPI:1982849212
Name:ATWOOD, JAKE R (DMD)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:R
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2478 PATTERSON RD
Mailing Address - Street 2:UNIT 22
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505
Mailing Address - Country:US
Mailing Address - Phone:970-241-2430
Mailing Address - Fax:970-644-5144
Practice Address - Street 1:2478 PATTERSON RD
Practice Address - Street 2:UNIT 22
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-241-2430
Practice Address - Fax:970-644-5144
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7134265-9921122300000X
CO002022301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist