Provider Demographics
NPI:1043518640
Name:GRASS, COLLEEN G (RDH)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:G
Last Name:GRASS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 HARNESS LOOP
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6011
Mailing Address - Country:US
Mailing Address - Phone:406-227-7512
Mailing Address - Fax:
Practice Address - Street 1:3248 HARNESS LOOP
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6011
Practice Address - Country:US
Practice Address - Phone:406-227-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT189124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist