Provider Demographics
NPI:1417169400
Name:EPPERLY, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:EPPERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 FIRESTONE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6427
Mailing Address - Country:US
Mailing Address - Phone:303-532-3371
Mailing Address - Fax:
Practice Address - Street 1:6160 FIRESTONE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6427
Practice Address - Country:US
Practice Address - Phone:303-532-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905005124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist