Healthcare Provider Details

I. General information

NPI: 1437660495
Provider Name (Legal Business Name): ABIGAIL HUGHEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 STONE CANYON RD
LONGMONT CO
80503-7319
US

IV. Provider business mailing address

1121 STONE CANYON RD
LONGMONT CO
80503-7319
US

V. Phone/Fax

Practice location:
  • Phone: 720-884-6187
  • Fax: 720-884-6187
Mailing address:
  • Phone: 720-884-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905830
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: