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General NPI Number Information
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NPI Number | 1316382682
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Entity Type | Organization
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Legal Business Name | HIGH MOUNTAIN HYGIENE, PC
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 548 FRONT ST. SUITE C
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City | FAIRPLAY
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State | CO
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Zip | 80440
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Country | US
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Telephone | 719-836-0967
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Fax | 719-836-0967
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | FAIRPLAY
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State | CO
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Zip | 80440-0967
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Country | US
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Telephone | 719-836-0967
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Fax | 719-836-0967
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | MARTA SUE BUTLER-BEARZI
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Credential | RDH
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Telephone | 719-836-0967
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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 | 200621
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License Number State | CO
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