Provider Demographics
NPI:1437436441
Name:WILLIAMS MOBILE DENTAL HYGIENE
Entity Type:Organization
Organization Name:WILLIAMS MOBILE DENTAL HYGIENE
Other - Org Name:MOTOR MOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:719-648-9102
Mailing Address - Street 1:6975 HOLT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1608
Mailing Address - Country:US
Mailing Address - Phone:719-648-9102
Mailing Address - Fax:719-358-6009
Practice Address - Street 1:6975 HOLT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1608
Practice Address - Country:US
Practice Address - Phone:719-648-9102
Practice Address - Fax:719-358-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH-905614261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1598070997OtherINDIVIDUAL NPI