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General NPI Number Information
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NPI Number | 1760305270
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Entity Type | Organization
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Legal Business Name | ROOTED RADIANCE DENTAL HYGIENE PLLC
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/01/2026
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Provider Practice Location Address
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Address Line | 115 WILCOX ST STE 200
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City | CASTLE ROCK
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State | CO
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Zip | 80104-2049
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Country | US
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Telephone | 785-760-0105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | ELIZABETH
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State | CO
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Zip | 80107-0222
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Country | US
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Telephone | 785-760-0105
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Fax |
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Authorized Official
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Title or Position | OWNER/RDH
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Name | STEPHANIE HODGE
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Credential | RDH
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Telephone | 785-760-0105
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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 |
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License Number State |
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