MEDICARE: MRS. YANIRA OWENS RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	904989	CO

General Provider Information

NPI Number	:	1174860753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YANIRA OWENS RDH

Provider Business Mailing Address
First Line	:	18525 E SMOKY HILL RD
Second Line	:	SUITE D
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3108
Country	:	US
Telephone Number	:	303-617-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	18525 E SMOKY HILL RD
Second Line	:	SUITE D
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-3108
Country	:	US
Telephone Number	:	303-617-9090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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