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General NPI Number Information
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NPI Number | 1811325822
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Entity Type | Individual
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Provider Name | SUSAN L BOTHWELL RDH
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Gender | Female
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 236 S 3RD ST #294
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City | MONTROSE
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State | CO
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Zip | 81401-3618
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Country | US
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Telephone | 970-240-2720
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Fax | 970-240-2724
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Provider Business Mailing Address
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Address Line | 626 N 4TH ST
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City | MONTROSE
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State | CO
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Zip | 81401-3520
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Country | US
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Telephone | 970-417-4414
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Fax | 970-240-2724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 000902869
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License Number State | CO
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