Provider Demographics
NPI:1508291659
Name:COLUMBINE DENTAL HYGIENE, PLLC
Entity Type:Organization
Organization Name:COLUMBINE DENTAL HYGIENE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENE
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-964-4546
Mailing Address - Street 1:816 S 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5765
Mailing Address - Country:US
Mailing Address - Phone:970-964-4546
Mailing Address - Fax:970-964-4534
Practice Address - Street 1:816 S 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-964-4546
Practice Address - Fax:970-964-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904695261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental