Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000902809 | CO |
NPI | 1043740822 |
---|---|
Provider Name | Ande Carol West |
First Address | Colorado Springs, CO 80909-5302 |
Second Address | Colorado Springs, CO 80909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |