MEDICARE: DANIELLE RATCLIFF RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1073083309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE RATCLIFF RDH

Provider Business Mailing Address
First Line	:	1805 HIGHWAY 42
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 HIGHWAY 42
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2588
Country	:	US
Telephone Number	:	303-666-8820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	11/29/2018

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