Provider Demographics
NPI:1174006043
Name:HEALTHY SMILES HYGIENE
Entity Type:Organization
Organization Name:HEALTHY SMILES HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDRA
Authorized Official - Suffix:
Authorized Official - Credentials:BSRDH
Authorized Official - Phone:303-838-7003
Mailing Address - Street 1:25997 CONIFER RD STE C
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9057
Mailing Address - Country:US
Mailing Address - Phone:303-838-7003
Mailing Address - Fax:303-648-6804
Practice Address - Street 1:25997 CONIFER RD STE C
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9057
Practice Address - Country:US
Practice Address - Phone:303-838-7003
Practice Address - Fax:303-648-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905358124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43730108Medicaid