Healthcare Provider Details

I. General information

NPI: 1902271737
Provider Name (Legal Business Name): JOY DRISCOLL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST BLDG B
FORT COLLINS CO
80526-1827
US

IV. Provider business mailing address

PO BOX 272241
FORT COLLINS CO
80527-2241
US

V. Phone/Fax

Practice location:
  • Phone: 612-910-8616
  • Fax:
Mailing address:
  • Phone: 612-910-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2829
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: