Healthcare Provider Details

I. General information

NPI: 1629812342
Provider Name (Legal Business Name): MARLENNE HOLGUIN-BUJANDA DH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S PUBLIC RD
LAFAYETTE CO
80026-7093
US

IV. Provider business mailing address

1735 S PUBLIC RD
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4460
  • Fax: 720-565-4129
Mailing address:
  • Phone: 303-650-4460
  • Fax: 720-565-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002027085
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: