MEDICARE: JEAN K DEMBOWSKI 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	904184	CO

General Provider Information

NPI Number	:	1407235146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN K DEMBOWSKI RDH

Provider Business Mailing Address
First Line	:	9298 SPIRIT CT
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80138-7850
Country	:	US
Telephone Number	:	720-842-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	17167 CEDAR GULCH PKWY
Second Line	:	102
City	:	PARKER
State	:	CO
Zip	:	80134-4411
Country	:	US
Telephone Number	:	303-814-5313
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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