MEDICARE: DENTAL HYGIENE WELLNESS CLINIC

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 000906510	CO

General Provider Information

NPI Number	:	1750778270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HYGIENE WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	2905 INCA ST
Second Line	:	2047
City	:	DENVER
State	:	CO
Zip	:	80202-1023
Country	:	US
Telephone Number	:	720-456-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 INCA ST
Second Line	:	2047
City	:	DENVER
State	:	CO
Zip	:	80202-1023
Country	:	US
Telephone Number	:	720-456-9050
Fax Number	:

Authorized Official
Title or Position	:	DENTAL HYGIENIST
Name	:	JANKEE H BHATT
Credential	:	RDH
Telephone Number	:	720-456-9050

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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