Provider Demographics
NPI:1952721037
Name:TRUE GRIN DENTAL HYGIENE SERVICES, LLC
Entity Type:Organization
Organization Name:TRUE GRIN DENTAL HYGIENE SERVICES, LLC
Other - Org Name:TRUE GRIN DENTAL HYGIENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-249-4746
Mailing Address - Street 1:236 S 3RD ST # 294
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3618
Mailing Address - Country:US
Mailing Address - Phone:970-249-4746
Mailing Address - Fax:970-249-1344
Practice Address - Street 1:226 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4234
Practice Address - Country:US
Practice Address - Phone:970-249-4746
Practice Address - Fax:970-249-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
CODH200841261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04775031Medicaid
CO20156341Medicaid