MEDICARE: COLTON BAINES 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	DH.002025430	CO

General Provider Information

NPI Number	:	1629634076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON BAINES RDH

Provider Business Mailing Address
First Line	:	10423 VIENNA ST APT 107
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-3874
Country	:	US
Telephone Number	:	720-775-9981
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 W EVANS AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80219-5507
Country	:	US
Telephone Number	:	720-636-9828
Fax Number	:

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

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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Directions to “ COLTON BAINES RDH” Practice Location

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