Provider Demographics
NPI:1295323731
Name:JUST FOR GRINS LLC
Entity type:Organization
Organization Name:JUST FOR GRINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-375-0690
Mailing Address - Street 1:11876 STAPLETON DR
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8438
Mailing Address - Country:US
Mailing Address - Phone:719-375-0690
Mailing Address - Fax:
Practice Address - Street 1:11876 STAPLETON DR
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-8438
Practice Address - Country:US
Practice Address - Phone:719-375-0690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental