Healthcare Provider Details

I. General information

NPI: 1275076085
Provider Name (Legal Business Name): CECILIA ESQUEDA-MENDEZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W 72ND AVE
DENVER CO
80221-2721
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4460
  • Fax: 720-565-4128
Mailing address:
  • Phone: 303-665-3036
  • Fax: 303-665-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002024476
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: