Healthcare Provider Details

I. General information

NPI: 1255967626
Provider Name (Legal Business Name): ROXANNE KAY POWERS RDH,MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 COLLINGSWOOD DR
FORT COLLINS CO
80524-1566
US

IV. Provider business mailing address

705 COLLINGSWOOD DR
FORT COLLINS CO
80524-1566
US

V. Phone/Fax

Practice location:
  • Phone: 970-481-6292
  • Fax:
Mailing address:
  • Phone: 970-481-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000002567
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: