MEDICARE: MRS. GRETCHEN L TIGHE 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	002024101	CO

General Provider Information

NPI Number	:	1285095620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETCHEN L TIGHE RDH

Provider Business Mailing Address
First Line	:	5910 STETSON HILLS BLVD
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3580
Country	:	US
Telephone Number	:	307-631-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5910 STETSON HILLS BLVD
Second Line	:	SUITE 110
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3580
Country	:	US
Telephone Number	:	307-631-3364
Fax Number	:

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

Provider Enumeration Date	:	03/13/2016
Last Update Date	:	03/13/2016

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