MEDICARE: DENTAL CARE IN YOUR HOME, INC.

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	DH227	NM

General Provider Information

NPI Number	:	1518266972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL CARE IN YOUR HOME, INC.

Provider Business Mailing Address
First Line	:	8104 CEDAR CREEK DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-3844
Country	:	US
Telephone Number	:	505-615-0951
Fax Number	:

Provider Business Practice Location Address
First Line	:	8104 CEDAR CREEK DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-3844
Country	:	US
Telephone Number	:	505-615-0951
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OF THE BOARD OF DIRECTORS
Name	:	MRS. CATHERINE MARY ELLIOTT
Credential	:	RDH
Telephone Number	:	505-615-0951

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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