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General NPI Number Information
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NPI Number | 1942446786
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES DENTAL HYGIENE CARE, INC.
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 144 N MAIN ST SUITE D
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City | GUNNISON
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State | CO
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Zip | 81230-2365
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Country | US
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Telephone | 970-642-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 144 N MAIN ST SUITE D
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City | GUNNISON
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State | CO
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Zip | 81230-2365
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Country | US
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Telephone | 970-642-0338
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTAL HYGIENIST
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Name | MRS. LESLIE ANN HEARNE
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Credential | RDH
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Telephone | 970-642-0338
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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 | 201441
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License Number State | CO
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