Provider Demographics
NPI:1417315615
Name:MARDON, DORI (RDH)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:MARDON
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 1:1758 CHAUTAUQUA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1877
Mailing Address - Country:US
Mailing Address - Phone:719-641-4747
Mailing Address - Fax:
Practice Address - Street 1:6430 BROOK PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1432
Practice Address - Country:US
Practice Address - Phone:719-268-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904260124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist