NPIMap

Organization Active NPI

Just for Grins LLC

  • General Practice Dentistry
  • Fountain, CO
National Provider Identifier
1205028941
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8170 Issued in CO
Legal business name
JUST FOR GRINS LLC
Practice address
6436 S US Highway 85-87
Suite C
Fountain, CO 80817
Phone
(719) 392-5111
Fax
(719) 392-4143
NPI assigned
Aug 16, 2007
Last updated
Jan 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dominique Pacheco
Title
Business Manager
Phone
(719) 392-5111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 8170 CO Primary

Addresses

Primary practice location

6436 S US Highway 85-87
Suite C
Fountain, CO 80817

Mailing address

6436 S US Highway 85-87
Suite C
Fountain, CO 80817-1005
Phone (719) 392-5111

Other practice location 1

11876 Stapleton Dr
Peyton, CO 80831-8438
Phone (719) 375-0690

Other identifiers 1

IdentifierTypeStateIssuer
31100058MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Just for Grins LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1205028941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6436 S US HIGHWAY 85-87",
            "address_2": "SUITE C",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808171005",
            "telephone_number": "719-392-5111",
            "fax_number": "719-392-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6436 S US HIGHWAY 85-87",
            "address_2": "SUITE C",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "80817",
            "telephone_number": "719-392-5111",
            "fax_number": "719-392-4143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11876 Stapleton Dr",
            "address_purpose": "LOCATION",
            "city": "Peyton",
            "state": "CO",
            "postal_code": "808318438",
            "country_code": "US",
            "telephone_number": "719-375-0690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JUST FOR GRINS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "719-392-5111"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31100058",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.