Healthcare Provider Details

I. General information

NPI: 1316265853
Provider Name (Legal Business Name): TRISHA HOBART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GRANT ST STE 200
THORNTON CO
80229-4361
US

IV. Provider business mailing address

4210 S PENNSYLVANIA ST
ENGLEWOOD CO
80113-4750
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-3690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905070
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: