Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | CO |
NPI | 1073065868 |
---|---|
Provider Name | Carole Collins |
First Address | Parker, CO 80138-4627 |
Second Address | Parker, CO 80138-4627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2016 |
Last Update Date | 27/10/2016 |