Provider Demographics
NPI:1336544642
Name:HMJ PC
Entity Type:Organization
Organization Name:HMJ PC
Other - Org Name:PARK AVENUE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:
Authorized Official - Last Name:JEBRIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-466-7438
Mailing Address - Street 1:3215 W 112TH CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-7199
Mailing Address - Country:US
Mailing Address - Phone:303-466-7439
Mailing Address - Fax:
Practice Address - Street 1:230 PARK AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1928
Practice Address - Country:US
Practice Address - Phone:303-857-2258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty