Provider Demographics
NPI:1194398396
Name:SILLANPA, CHRISTIE NICOLE (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:NICOLE
Last Name:SILLANPA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:NICOLE
Other - Last Name:HEWETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 DILLON RIDGE RD STE C246
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-5405
Mailing Address - Country:US
Mailing Address - Phone:970-485-9593
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR # 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5948
Practice Address - Country:US
Practice Address - Phone:970-668-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906020124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist