Healthcare Provider Details

I. General information

NPI: 1053716308
Provider Name (Legal Business Name): MICHELE REWERTS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE PROPES RDH

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 3RD ST SE SUITE 150
LOVELAND CO
80537-6419
US

IV. Provider business mailing address

2930 11TH AVE
EVANS CO
80620-1011
US

V. Phone/Fax

Practice location:
  • Phone: 970-461-8942
  • Fax: 970-292-1538
Mailing address:
  • Phone: 970-350-4606
  • Fax: 970-350-4692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2023953
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: