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General NPI Number Information
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NPI Number | 1437436441
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Entity Type | Organization
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Legal Business Name | WILLIAMS MOBILE DENTAL HYGIENE
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 6975 HOLT DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1608
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Country | US
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Telephone | 719-648-9102
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Fax | 719-358-6009
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Provider Business Mailing Address
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Address Line | 6975 HOLT DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-1608
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Country | US
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Telephone | 719-648-9102
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Fax | 719-358-6009
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. HEATHER LYNETTE WILLIAMS
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Credential | RDH
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Telephone | 719-648-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DH-905614
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License Number State | CO
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