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General NPI Number Information
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NPI Number | 1629503669
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Entity Type | Organization
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Legal Business Name | EARLY ORAL HEALTH INTERCEPTION LLC
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 235 CARSON AVENUE
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City | ALAMOSA
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State | CO
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Zip | 81101
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Country | US
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Telephone | 720-206-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 S VERBENA ST
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City | DENVER
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State | CO
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Zip | 80247-3089
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Country | US
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Telephone | 720-206-9031
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Fax |
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Authorized Official
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Title or Position | REGISTERED DENTAL HYGIENIST
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Name | MARIA FRANCISCO-MATIAS
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Credential | RDH
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Telephone | 720-206-9031
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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 | 904246
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License Number State | CO
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