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General NPI Number Information
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NPI Number | 1831820851
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Entity Type | Organization
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Legal Business Name | SUMMIT DENTAL HYGIENE
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 300 W LAKE AVE
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City | WOODLAND PARK
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State | CO
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Zip | 80863-5046
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Country | US
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Telephone | 719-285-7154
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4000
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City | WOODLAND PARK
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State | CO
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Zip | 80866-4000
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Country | US
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Telephone | 719-285-7154
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | LISA HELLAND
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Credential | RDH
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Telephone | 719-285-7154
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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 |
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License Number State |
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