Fun at the Dentist Professional LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

104423 Issued in CO

Legal business name

FUN AT THE DENTIST PROFESSIONAL LLC

Practice address

2525 N 8TH St
Suite 105
Grand Junction, CO 81501-8845

Phone

(970) 255-1111

Fax

(970) 241-5555

NPI assigned

Apr 6, 2012

Last updated

Apr 6, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Glen R Dean, DDS, MS

Title

President

Phone

(970) 255-1111

Specialties & licenses 1

Addresses

Tax ID family

Fun at the Dentist Professional LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Fun at the Dentist Professional LLC

  • Pediatric Dentistry
  • Grand JCT, CO
  • NPI 1316541733
  NPD tax ID

Locations

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1467718155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 N 8TH ST",
            "address_2": "SUITE 105",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018845",
            "telephone_number": "970-255-1111",
            "fax_number": "970-241-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 N 8TH ST",
            "address_2": "SUITE 105",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018845",
            "telephone_number": "970-255-1111",
            "fax_number": "970-241-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUN AT THE DENTIST PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "DEAN",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-255-1111",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "104423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Kathleen Fuller, RD
• Joshua Fullmer, MS, ATC
• Rebecca Fulmer, M.D.
• Courtney Fulton, M.D.
• Richard Eustis Fulton III, M.D.
• Cathy Mary Funderburk, RN
• Joseph Robert Funderburk, DDS
• Kira Debell Funderburk, D.D.S.
• Megan Marie Funke
• Kimberly Ehrlich Furr, OTR

• Pediatric Dentistry in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Pediatric Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; 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.