Healthcare Provider Details

I. General information

NPI: 1396016986
Provider Name (Legal Business Name): LINDA S DUSKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 WETZEL AVE BLDG 815
FORT CARSON CO
80913-4095
US

IV. Provider business mailing address

1631 WETZEL AVE BLDG 815
FORT CARSON CO
80913-4095
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5537
  • Fax: 719-526-5551
Mailing address:
  • Phone: 719-526-5537
  • Fax: 719-526-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902002714
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHD-903109
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: