Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH.002025877 | CO |
NPI | 1003575507 |
---|---|
Provider Name | Tonya Lange |
First Address | Alma, CO 80420-0353 |
Second Address | Breckenridge, CO 80424-6498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2021 |
Last Update Date | 12/12/2021 |