Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000906187 | CO |
NPI | 1043784226 |
---|---|
Provider Name | Candace Mccutcheon |
First Address | Lone Tree, CO 80124-9599 |
Second Address | Lone Tree, CO 80124-9599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2019 |
Last Update Date | 21/01/2019 |