Provider Demographics
NPI:1093386088
Name:POWELL, DANI JUNE (RDH)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:JUNE
Last Name:POWELL
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 1:114 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-7001
Mailing Address - Country:US
Mailing Address - Phone:970-580-5991
Mailing Address - Fax:
Practice Address - Street 1:114 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-7001
Practice Address - Country:US
Practice Address - Phone:970-580-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3056124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist