Provider Demographics
NPI:1346697752
Name:RENAISSANCE DENTAL HYGIENE RDH LLC
Entity Type:Organization
Organization Name:RENAISSANCE DENTAL HYGIENE RDH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH BSDH
Authorized Official - Phone:303-596-7634
Mailing Address - Street 1:6214 E 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9691
Mailing Address - Country:US
Mailing Address - Phone:303-596-7634
Mailing Address - Fax:
Practice Address - Street 1:6214 E 122ND AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9691
Practice Address - Country:US
Practice Address - Phone:303-596-7634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2675124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36651524Medicaid