Healthcare Provider Details

I. General information

NPI: 1629634076
Provider Name (Legal Business Name): COLTON BAINES RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 W EVANS AVE
DENVER CO
80219-5507
US

IV. Provider business mailing address

10423 VIENNA ST APT 107
PARKER CO
80134-3874
US

V. Phone/Fax

Practice location:
  • Phone: 720-636-9828
  • Fax:
Mailing address:
  • Phone: 720-775-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002025430
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: