Healthcare Provider Details

I. General information

NPI: 1497278550
Provider Name (Legal Business Name): MICHELE SAMSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 LOWELL BLVD
DENVER CO
80211-1364
US

IV. Provider business mailing address

5101 S RIO GRANDE ST APT 7-200
LITTLETON CO
80120-8273
US

V. Phone/Fax

Practice location:
  • Phone: 303-455-8962
  • Fax:
Mailing address:
  • Phone: 720-339-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000904678
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: