Healthcare Provider Details

I. General information

NPI: 1629484563
Provider Name (Legal Business Name): TERESA MCDONALD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 W 84TH AVE
FEDERAL HEIGHTS CO
80260-4780
US

IV. Provider business mailing address

13043 TRENTON PL
THORNTON CO
80602-8434
US

V. Phone/Fax

Practice location:
  • Phone: 303-426-4860
  • Fax:
Mailing address:
  • Phone: 303-358-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2261
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: