Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002026081 | CO |
NPI | 1043888472 |
---|---|
Provider Name | Melody Siregar |
First Address | Westminster, CO 80031-7007 |
Second Address | Westminster, CO 80031-7007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2021 |
Last Update Date | 13/06/2021 |