Healthcare Provider Details

I. General information

NPI: 1346227600
Provider Name (Legal Business Name): CARRIE MARLENE DENTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N AVENIDA DE LA TUCA
TUCSON AZ
85710-1419
US

IV. Provider business mailing address

30 N AVENIDA DE LA TUCA
TUCSON AZ
85710-1419
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-1545
  • Fax: 520-228-2834
Mailing address:
  • Phone: 520-228-1545
  • Fax: 520-228-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4884
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: