Healthcare Provider Details

I. General information

NPI: 1194767103
Provider Name (Legal Business Name): MARIA ANTONIA MCKENZIE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15132 E HAMPDEN AVE SUITE G
AURORA CO
80014-5072
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80115-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-6546
  • Fax: 303-762-6550
Mailing address:
  • Phone: 303-361-1977
  • Fax: 303-761-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.000904142
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: