Provider Demographics
NPI:1275000333
Name:JENNINGS, ALYSIA CHRISTINE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ALYSIA
Middle Name:CHRISTINE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:CHRISTINE
Other - Last Name:THEODOROU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:3974 DONNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3415
Mailing Address - Country:US
Mailing Address - Phone:949-939-5291
Mailing Address - Fax:
Practice Address - Street 1:3525 W OXFORD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3106
Practice Address - Country:US
Practice Address - Phone:303-315-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist