Provider Demographics
NPI:1316382682
Name:HIGH MOUNTAIN HYGIENE, PC
Entity Type:Organization
Organization Name:HIGH MOUNTAIN HYGIENE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BUTLER-BEARZI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:719-836-0967
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0967
Mailing Address - Country:US
Mailing Address - Phone:719-836-0967
Mailing Address - Fax:719-836-0967
Practice Address - Street 1:548 FRONT ST.
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440
Practice Address - Country:US
Practice Address - Phone:719-836-0967
Practice Address - Fax:719-836-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO200621124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty