Healthcare Provider Details

I. General information

NPI: 1275922940
Provider Name (Legal Business Name): STELLA MARIE FARLEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 01/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6169 S BALSAM WAY SUITE 330
LITTLETON CO
80123-3062
US

IV. Provider business mailing address

6169 S BALSAM WAY SUITE 330
LITTLETON CO
80123-3062
US

V. Phone/Fax

Practice location:
  • Phone: 303-933-8230
  • Fax: 303-933-8232
Mailing address:
  • Phone: 303-933-8230
  • Fax: 303-933-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH000002485
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: