Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00202347 | CO |
N | 124Q00000X | Dental Hygienist | H6765 | AZ |
NPI | 1063729457 |
---|---|
Provider Name | Diane Marie Scott |
First Address | Thornton, CO 80229 |
Second Address | Denver, CO 80204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2010 |
Last Update Date | 10/09/2014 |