Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH000904082 | CO |
NPI | 1073040028 |
---|---|
Provider Name | Tiffany Jene Schroeder |
First Address | Littleton, CO 80128-5217 |
Second Address | Lakewood, CO 80228-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2017 |
Last Update Date | 20/05/2017 |