Healthcare Provider Details

I. General information

NPI: 1760935829
Provider Name (Legal Business Name): CIMARRON DENTAL HYGIENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65700 LITTLE WAY
MONTROSE CO
81401-8385
US

IV. Provider business mailing address

65700 LITTLE WAY
MONTROSE CO
81401-8385
US

V. Phone/Fax

Practice location:
  • Phone: 970-393-0253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000904292
License Number StateCO

VIII. Authorized Official

Name: ALICIA G LAMPRECHT
Title or Position: OWNER/DENTAL HYGIENIST
Credential: RDH
Phone: 970-393-0253