Healthcare Provider Details

I. General information

NPI: 1265601926
Provider Name (Legal Business Name): JOLENE BADDING RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E 3RD AVENUE, SUITE 110
DURANGO CO
81301
US

IV. Provider business mailing address

128 MARKET STREET
ALAMOSA CO
81101
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-5930
  • Fax: 970-247-3143
Mailing address:
  • Phone: 719-589-5161
  • Fax: 719-589-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905343
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: