=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760935829
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIMARRON DENTAL HYGIENE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 07/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65700 LITTLE WAY
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81401-8385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-393-0253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 65700 LITTLE WAY
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81401-8385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTAL HYGIENIST
-----------------------------------------------------
Name | ALICIA G LAMPRECHT
-----------------------------------------------------
Credential | RDH
-----------------------------------------------------
Telephone | 970-393-0253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 000904292
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------