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General NPI Number Information
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NPI Number | 1346836749
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Entity Type | Individual
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Provider Name | TONI-ANN AYZENBERG RDH, BS
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Gender | Female
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Dates
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Enumeration Date | 12/19/2020
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Last Update Date | 12/19/2020
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Provider Practice Location Address
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Address Line | 950 BAPTIST RD STE 100
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City | MONUMENT
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State | CO
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Zip | 80132-7711
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Country | US
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Telephone | 719-481-5807
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 SHAWNEE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-3196
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Country | US
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Telephone |
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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 | 002025583
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License Number State | CO
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