Provider Demographics
NPI:1215811542
Name:PAINTED SKY DENTAL
Entity type:Organization
Organization Name:PAINTED SKY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-426-0062
Mailing Address - Street 1:370 FOREST LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9861
Mailing Address - Country:US
Mailing Address - Phone:970-426-0062
Mailing Address - Fax:
Practice Address - Street 1:370 FOREST LAKES DR
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9861
Practice Address - Country:US
Practice Address - Phone:970-426-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental