MEDICARE: MS. BARBARA CONKEY DENTAL HYGIENIST

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	903398	CO

General Provider Information

NPI Number	:	1518187483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA CONKEY DENTAL HYGIENIST

Provider Business Mailing Address
First Line	:	2009 LAKE FOREST CIR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9390
Country	:	US
Telephone Number	:	970-731-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LAKE FOREST CIR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9390
Country	:	US
Telephone Number	:	970-731-6877
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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