Healthcare Provider Details

I. General information

NPI: 1609312131
Provider Name (Legal Business Name): EAGLE CREEK DENTAL HYGIENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16061 6250 RD
MONTROSE CO
81403-7887
US

IV. Provider business mailing address

226 S NEVADA AVE
MONTROSE CO
81401-4234
US

V. Phone/Fax

Practice location:
  • Phone: 970-765-6753
  • Fax:
Mailing address:
  • Phone: 970-765-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000003046
License Number StateCO

VIII. Authorized Official

Name: EUGENIA LEE CATLIN
Title or Position: REGISTERED DENTAL HYGIENIST
Credential: RDH
Phone: 970-765-6753