Provider Demographics
NPI:1881319317
Name:DDS VANTAGE PLLC
Entity type:Organization
Organization Name:DDS VANTAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-201-9590
Mailing Address - Street 1:2412 PATTERSON RD STE 7
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1259
Mailing Address - Country:US
Mailing Address - Phone:970-243-2025
Mailing Address - Fax:970-243-2027
Practice Address - Street 1:818 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3501
Practice Address - Country:US
Practice Address - Phone:970-230-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty