Provider Demographics
NPI:1831725647
Name:GRENILLO-WEAVER, CALE JEFFERY
Entity type:Individual
Prefix:
First Name:CALE
Middle Name:JEFFERY
Last Name:GRENILLO-WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5538
Mailing Address - Country:US
Mailing Address - Phone:720-369-4897
Mailing Address - Fax:
Practice Address - Street 1:84 GARRISON ST STE A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-7427
Practice Address - Country:US
Practice Address - Phone:303-223-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002051041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice