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General NPI Number Information
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NPI Number | 1508291659
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Entity Type | Organization
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Legal Business Name | COLUMBINE DENTAL HYGIENE, PLLC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 816 S 5TH ST STE A
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City | MONTROSE
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State | CO
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Zip | 81401-5765
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Country | US
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Telephone | 970-964-4546
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Fax | 970-964-4534
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Provider Business Mailing Address
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Address Line | 816 S 5TH ST STE A
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City | MONTROSE
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State | CO
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Zip | 81401-5765
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Country | US
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Telephone | 970-964-4546
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Fax | 970-964-4534
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Authorized Official
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Title or Position | DENTAL HYGIENE
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Name | KELLIE LYNNE REED
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Credential | RDH
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Telephone | 970-964-4546
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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 | 904695
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License Number State | CO
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