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General NPI Number Information
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NPI Number | 1174110803
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Entity Type | Individual
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Provider Name | JANNELLE LYNN RALEY RDH
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Gender | Female
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 12889 QUEBEC ST
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City | THORNTON
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State | CO
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Zip | 80602-9623
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Country | US
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Telephone | 720-726-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 6636 W 95TH PL
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City | BROOMFIELD
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State | CO
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Zip | 80021-6425
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Country | US
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Telephone | 303-667-9337
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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.000905694
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License Number State | CO
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