Healthcare Provider Details

I. General information

NPI: 1700318383
Provider Name (Legal Business Name): AMY KATHLEEN DZURNAK R.D.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 04/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 WEWATTA WAY UNIT 2006
DENVER CO
80216-3622
US

IV. Provider business mailing address

2797 WEWATTA WAY UNIT 2006
DENVER CO
80216-3622
US

V. Phone/Fax

Practice location:
  • Phone: 586-243-8748
  • Fax:
Mailing address:
  • Phone: 586-243-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002024558
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902015928
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: