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General NPI Number Information
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NPI Number | 1548709835
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Entity Type | Organization
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Legal Business Name | R S K LLC
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 611 4TH STREET B
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City | CRESTED BUTTE
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State | CO
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Zip | 81224
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Country | US
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Telephone | 970-349-7092
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4110
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City | CRESTED BUTTE
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State | CO
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Zip | 81224-3709
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Country | US
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Telephone | 970-349-7092
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. SUNNI HAMILTON
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Credential | RDH
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Telephone | 970-349-7092
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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 | 002023818
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License Number State | CO
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