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NPI Code Detail

MEDICARE: PREMIER DENTAL HEALTH L.L.C.

MEDICARE: PREMIER DENTAL HEALTH L.L.C.
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
1124Q00000XDental Hygienist2806CO

General Provider Information

NPI Number : 1710221783
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER DENTAL HEALTH L.L.C.
Provider Business Mailing Address
First Line : PO BOX 1961
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81602-1961
Country : US
Telephone Number : 970-379-8030
Fax Number :
Provider Business Practice Location Address
First Line : 214 8TH ST
Second Line : SUITE 305
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-3326
Country : US
Telephone Number : 970-379-8030
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. PAMELA MILLER
Credential : RDH
Telephone Number : 970-379-8030
Provider Enumeration Date : 11/15/2012
Last Update Date : 11/15/2012

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Directions to “PREMIER DENTAL HEALTH L.L.C. ” Practice Location

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