Provider Demographics
NPI:1538680178
Name:JMJ III
Entity type:Organization
Organization Name:JMJ III
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-687-6366
Mailing Address - Street 1:1101 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813
Mailing Address - Country:US
Mailing Address - Phone:719-689-3565
Mailing Address - Fax:719-689-0153
Practice Address - Street 1:1101 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813-8081
Practice Address - Country:US
Practice Address - Phone:719-689-3565
Practice Address - Fax:719-689-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JMJ III
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty