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General NPI Number Information
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NPI Number | 1174053979
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Entity Type | Individual
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Provider Name | AUDRINA BUSCH RDH
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 729 E RAILROAD AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-3340
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Country | US
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Telephone | 303-697-2583
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Fax |
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Provider Business Mailing Address
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Address Line | 19443 E 59TH AVE
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City | AURORA
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State | CO
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Zip | 80019-2010
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Country | US
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Telephone |
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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 | DH.002024786
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License Number State | CO
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