Healthcare Provider Details

I. General information

NPI: 1487066536
Provider Name (Legal Business Name): JENNY D FILTER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E 1ST ST
SALIDA CO
81201-2803
US

IV. Provider business mailing address

427 E 1ST ST
SALIDA CO
81201-2803
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-6142
  • Fax: 719-539-6186
Mailing address:
  • Phone: 719-539-6142
  • Fax: 719-539-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7143
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0000200079
License Number StateCO

VIII. Authorized Official

Name: DR. JENNY D FILTER
Title or Position: OWNER PC
Credential: DDS
Phone: 719-539-6142