Provider Demographics
NPI:1447344312
Name:JOHN P. POOVEY, D.M.D., P.C.
Entity type:Organization
Organization Name:JOHN P. POOVEY, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-243-2025
Mailing Address - Street 1:132 WALNUT AVE STE E
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-243-2025
Mailing Address - Fax:970-243-2027
Practice Address - Street 1:132 WALNUT AVE STE E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-243-2025
Practice Address - Fax:970-243-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83161223G0001X
CO90331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty