Healthcare Provider Details

I. General information

NPI: 1285850289
Provider Name (Legal Business Name): GLENDA KAY LINDSAY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST STREET
LIMON CO
80828-1120
US

IV. Provider business mailing address

820 1ST STREET
LIMON CO
80828-1120
US

V. Phone/Fax

Practice location:
  • Phone: 719-775-2367
  • Fax: 719-775-2365
Mailing address:
  • Phone: 719-775-2367
  • Fax: 719-775-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number904070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: