Healthcare Provider Details

I. General information

NPI: 1457282279
Provider Name (Legal Business Name): JANIECE C ERVIN RDH, BSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20250 E SMOKY HILL RD UNIT 4
CENTENNIAL CO
80015-3118
US

IV. Provider business mailing address

20250 E SMOKY HILL RD UNIT 4
CENTENNIAL CO
80015-3118
US

V. Phone/Fax

Practice location:
  • Phone: 720-209-4482
  • Fax:
Mailing address:
  • Phone: 720-209-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH000905525
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: