Healthcare Provider Details

I. General information

NPI: 1396192985
Provider Name (Legal Business Name): COLLEEN TROMBLY MHSA, RDH, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 E STILL CIR
MESA AZ
85206-3618
US

IV. Provider business mailing address

5835 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-6112
  • Fax:
Mailing address:
  • Phone: 480-219-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8338
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: