Healthcare Provider Details

I. General information

NPI: 1952016339
Provider Name (Legal Business Name): RABBIT EARS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W VICTORY WAY STE 104
CRAIG CO
81625-2954
US

IV. Provider business mailing address

1111 W VICTORY WAY STE 104
CRAIG CO
81625-2954
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-7976
  • Fax: 970-879-6710
Mailing address:
  • Phone: 970-879-7976
  • Fax: 970-879-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KOLBY LANCE
Title or Position: OWNER
Credential:
Phone: 435-790-4170