MEDICARE: LUANN JOYCE HUSMANN 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	DH-906103	CO

General Provider Information

NPI Number	:	1558645168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUANN JOYCE HUSMANN RDH

Provider Business Mailing Address
First Line	:	2222 GARRISON ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-1669
Country	:	US
Telephone Number	:	720-284-4804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 OGDEN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1910
Country	:	US
Telephone Number	:	303-863-0772
Fax Number	:

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

Provider Enumeration Date	:	09/30/2011
Last Update Date	:	09/30/2011

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