MEDICARE: THERESA RANKIN 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	904813	CO

General Provider Information

NPI Number	:	1306125950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA RANKIN RDH

Provider Business Mailing Address
First Line	:	PO BOX 775386
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-5386
Country	:	US
Telephone Number	:	970-879-9828
Fax Number	:	970-879-9858

Provider Business Practice Location Address
First Line	:	1560 PINE GROVE RD
Second Line	:	SUITE C
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487
Country	:	US
Telephone Number	:	980-879-9828
Fax Number	:	970-879-9858

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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