Provider Demographics
NPI:1518179258
Name:BROTHERS, LINDA JANE (RDH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JANE
Last Name:BROTHERS
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 1:104 WILD RIVER LANE
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230
Mailing Address - Country:US
Mailing Address - Phone:970-642-0338
Mailing Address - Fax:970-641-5364
Practice Address - Street 1:320 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-641-5363
Practice Address - Fax:970-641-5364
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
CO904700124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist