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General NPI Number Information
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NPI Number | 1235597725
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES HYGIENE
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 25997 CONIFER RD STE C
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City | CONIFER
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State | CO
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Zip | 80433-9057
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Country | US
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Telephone | 303-838-7003
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Fax | 303-648-6804
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Provider Business Mailing Address
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Address Line | 25997 CONIFER RD STE C
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City | CONIFER
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State | CO
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Zip | 80433-9057
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Country | US
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Telephone | 303-838-7003
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Fax | 303-648-6804
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE BOLDRA
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Credential | RDH
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Telephone | 303-838-7003
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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 | 905358
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License Number State | CO
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