Healthcare Provider Details

I. General information

NPI: 1558812883
Provider Name (Legal Business Name): CHRISTINE MIGUEL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE GRACE FLORES MIGUEL-GREENWOOD R.D.H.

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 PEORIA ST
AURORA CO
80010-1517
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-6276
  • Fax: 303-467-5355
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-467-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002023922
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberLOCAL.0000500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: