Healthcare Provider Details

I. General information

NPI: 1689510869
Provider Name (Legal Business Name): HART DENTAL HYGIENE-ELIZABETH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N ELIZABETH ST STE A
PUEBLO CO
81003-2159
US

IV. Provider business mailing address

1401 N ELIZABETH ST STE A
PUEBLO CO
81003-2159
US

V. Phone/Fax

Practice location:
  • Phone: 719-582-4741
  • Fax: 719-582-4742
Mailing address:
  • Phone: 719-582-4741
  • Fax: 719-582-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE MCARTHUR
Title or Position: OWNER
Credential: RDH
Phone: 719-582-4741