Healthcare Provider Details

I. General information

NPI: 1043784226
Provider Name (Legal Business Name): CANDACE MCCUTCHEON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 CHEETAH CHASE
LONE TREE CO
80124-9599
US

IV. Provider business mailing address

5885 CHEETAH CHASE
LONE TREE CO
80124-9599
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-2324
  • Fax:
Mailing address:
  • Phone: 619-992-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000906187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: