Provider Demographics
NPI:1285010983
Name:WHITE RIVER DENTAL HYGIENE, PLLC
Entity Type:Organization
Organization Name:WHITE RIVER DENTAL HYGIENE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-878-9967
Mailing Address - Street 1:73521 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-9302
Mailing Address - Country:US
Mailing Address - Phone:970-878-9967
Mailing Address - Fax:
Practice Address - Street 1:73521 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-9302
Practice Address - Country:US
Practice Address - Phone:970-878-9967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905168124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty