Healthcare Provider Details

I. General information

NPI: 1174892111
Provider Name (Legal Business Name): JEANNE MARIA MERLONI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 14TH
RIFLE CO
81650-4700
US

IV. Provider business mailing address

7192 COUNTY ROAD 312
NEW CASTLE CO
81647-8605
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-5200
  • Fax:
Mailing address:
  • Phone: 508-862-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number906476
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: