Healthcare Provider Details

I. General information

NPI: 1376757799
Provider Name (Legal Business Name): RENEE Y HALL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 SOUTH BOULDER ROAD
LOUISVILLE CO
80027
US

IV. Provider business mailing address

877 S. BOULDER ROAD
LOUISVILLE CO
80027
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-8228
  • Fax: 303-665-8994
Mailing address:
  • Phone: 303-665-8228
  • Fax: 303-665-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2675
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: