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General NPI Number Information
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NPI Number | 1346021318
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Entity Type | Individual
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Provider Name | CANDACE OWEN RDH, MS, MPH
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Gender | Female
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 2205 W 136TH AVE # 106-159
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City | BROOMFIELD
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State | CO
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Zip | 80023-9306
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Country | US
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Telephone | 708-650-6229
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 E 133RD AVE
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City | THORNTON
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State | CO
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Zip | 80602-8153
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Country | US
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Telephone | 719-588-2090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DH.002024860
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License Number State | CO
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