=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205346681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA WOYTEK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2017
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13606 XAVIER LN STE F
-----------------------------------------------------
City | BROOMFIELD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-3604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-465-4500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16105 WASHINGTON ST APT 6306
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80023-9029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-486-4687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 906124
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------