Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 905446 | CO |
NPI | 1023385291 |
---|---|
Provider Name | Jill Marie Rodriguez |
First Address | Lafayette, CO 80026-2832 |
Second Address | Thornton, CO 80229-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2011 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00170275 | (05) | CO |