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General NPI Number Information
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NPI Number | 1235541426
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Entity Type | Organization
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Legal Business Name | HEARTHSIDE DENTISTRY
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 16578 N WASHINGTON ST
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City | THORNTON
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State | CO
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Zip | 80023
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Country | US
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Telephone | 303-280-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 16578 N WASHINGTON ST
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City | THORNTON
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State | CO
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Zip | 80023
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Country | US
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Telephone | 303-280-2285
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | CHRISTINA MCMILLON
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Credential | DMD
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Telephone | 303-280-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10391
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License Number State | CO
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