Healthcare Provider Details

I. General information

NPI: 1548650435
Provider Name (Legal Business Name): JAYME HOVLAND DH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LOWER WOODBRIDGE ROAD
SNOWMASS VILLAGE CO
81615
US

IV. Provider business mailing address

BOX 5777 25 LOWER WOODBRIDGE ROAD
SNOWMASS VILLAGE CO
81615
US

V. Phone/Fax

Practice location:
  • Phone: 970-923-5777
  • Fax:
Mailing address:
  • Phone: 970-923-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number000904049
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: