Blue Mesa Dental Assoc PC

Primary specialty

DentistTaxonomy code 122300000X

License

6619 Issued in CO

Legal business name

BLUE MESA DENTAL ASSOC PC

Practice address

1700 S Chambers Rd
Aurora, CO 80017-5023

Phone

(303) 337-0789

Fax

(303) 671-2601

NPI assigned

Jan 17, 2007

Last updated

Aug 22, 2020By 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

Ms. Norma Berenice Grijalua

Title

Office Manager

Phone

(303) 337-0789

Specialties & licenses 2

Addresses

Other names 1

• Blue Mesa Dental of Aurora Other name

Locations

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841342300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S CHAMBERS RD",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800175023",
            "telephone_number": "303-337-0789",
            "fax_number": "303-671-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S CHAMBERS RD",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800175023",
            "telephone_number": "303-337-0789",
            "fax_number": "303-671-2601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MESA DENTAL ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRIJALUA",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "BERENICE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "303-337-0789",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "6619",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "8934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Mesa Dental of Aurora",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.