Provider Demographics
NPI:1780287235
Name:CRESTED OAK DENTISTRY PLLC
Entity type:Organization
Organization Name:CRESTED OAK DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-4800
Mailing Address - Street 1:2532 PATTERSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-3607
Mailing Address - Country:US
Mailing Address - Phone:970-214-4800
Mailing Address - Fax:970-241-8266
Practice Address - Street 1:2532 PATTERSON RD STE 1
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3607
Practice Address - Country:US
Practice Address - Phone:970-241-4800
Practice Address - Fax:970-241-8266
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESTED OAK DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty