Healthcare Provider Details

I. General information

NPI: 1821976333
Provider Name (Legal Business Name): KHIA COOPER RDH, BS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 IDYLWILD TRL UNIT B
BOULDER CO
80301-3816
US

IV. Provider business mailing address

5464 MESA TOP CT
BOULDER CO
80301-3545
US

V. Phone/Fax

Practice location:
  • Phone: 720-378-6615
  • Fax:
Mailing address:
  • Phone: 303-815-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.000903882
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: