Healthcare Provider Details

I. General information

NPI: 1376865642
Provider Name (Legal Business Name): PATRICIA MICHELLE VACHA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 FLINTRIDGE DR
COLORADO SPRINGS CO
80918-4408
US

IV. Provider business mailing address

2604 FLINTRIDGE DR
COLORADO SPRINGS CO
80918-4408
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-7010
  • Fax: 719-596-7010
Mailing address:
  • Phone: 719-596-7010
  • Fax: 719-596-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number903783
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: