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General NPI Number Information
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NPI Number | 1306393335
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Entity Type | Organization
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Legal Business Name | CZECH UP, PC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1480 W 8TH ST UNIT 13
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City | ALAMOSA
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State | CO
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Zip | 81101-3027
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Country | US
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Telephone | 970-445-8713
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Fax |
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Provider Business Mailing Address
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Address Line | 1480 W 8TH ST UNIT 13
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City | ALAMOSA
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State | CO
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Zip | 81101-3027
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Country | US
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Telephone | 970-445-8713
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Fax |
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Authorized Official
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Title or Position | CEO,BUS.ADMIN.,DENTAL HYGIENIST
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Name | ALICE BARBARA LAURENT
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Credential | RDH
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Telephone | 970-445-8713
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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 | 905139
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License Number State | CO
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