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General NPI Number Information
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NPI Number | 1962819383
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Entity Type | Organization
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Legal Business Name | ASPEN TO PARACHUTE DENTAL HEALTH ALLIANCE
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 20 EAGLE COUNTY RD
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City | CARBONDALE
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State | CO
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Zip | 81623-9125
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Country | US
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Telephone | 970-309-2064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1251
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81602-1251
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Country | US
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Telephone | 970-309-2064
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Fax |
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Authorized Official
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Title or Position | REGIONAL ORAL HEALTH CONSULTATN
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Name | KELLY JEAN KEEFFE
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Credential | RDH
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Telephone | 970-309-2064
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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 | DH3120
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License Number State | CO
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