Healthcare Provider Details

I. General information

NPI: 1205346681
Provider Name (Legal Business Name): THERESA WOYTEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13606 XAVIER LN STE F
BROOMFIELD CO
80023-3604
US

IV. Provider business mailing address

16105 WASHINGTON ST APT 6306
THORNTON CO
80023-9029
US

V. Phone/Fax

Practice location:
  • Phone: 303-465-4500
  • Fax:
Mailing address:
  • Phone: 928-486-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number906124
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: