Provider Demographics
NPI:1326667429
Name:STURDEVANT, LAURILYN BALFOUR (RDH)
Entity Type:Individual
Prefix:
First Name:LAURILYN
Middle Name:BALFOUR
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 ROAD 27
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-9238
Mailing Address - Country:US
Mailing Address - Phone:307-689-7810
Mailing Address - Fax:
Practice Address - Street 1:101 N MAPLE
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321
Practice Address - Country:US
Practice Address - Phone:970-565-1800
Practice Address - Fax:833-245-0112
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000001587124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist