Healthcare Provider Details

I. General information

NPI: 1215166137
Provider Name (Legal Business Name): YVETTE ELIZABETH TATAJE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 ROCKY MOUNTAIN AVE SUITE 400
LOVELAND CO
80538-8705
US

IV. Provider business mailing address

1685 ROCKY MOUNTAIN AVE SUITE 400
LOVELAND CO
80538-8705
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-2121
  • Fax: 970-667-2323
Mailing address:
  • Phone: 970-667-2121
  • Fax: 970-667-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10122
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6915
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015632
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: