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General NPI Number Information
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NPI Number | 1346697752
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Entity Type | Organization
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Legal Business Name | RENAISSANCE DENTAL HYGIENE RDH LLC
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 6214 E 122ND AVE
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City | BRIGHTON
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State | CO
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Zip | 80602-9691
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Country | US
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Telephone | 303-596-7634
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Fax |
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Provider Business Mailing Address
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Address Line | 6214 E 122ND AVE
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City | BRIGHTON
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State | CO
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Zip | 80602-9691
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Country | US
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Telephone | 303-596-7634
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MS. RENEE Y HALL
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Credential | RDH BSDH
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Telephone | 303-596-7634
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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 | 2675
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License Number State | CO
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