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General NPI Number Information
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NPI Number | 1134341936
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Entity Type | Individual
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Provider Name | AMY LAURA PELOQUIN R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/15/2011
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Provider Practice Location Address
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Address Line | 211 MAIN STREET UNIT A
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City | ELIZABETH
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State | CO
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Zip | 80107
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Country | US
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Telephone | 303-653-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 42048 S PINEHURST CIR
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City | ELIZABETH
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State | CO
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Zip | 80107-9113
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Country | US
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Telephone | 303-653-2095
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 904903
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License Number State | CO
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