Provider Demographics
NPI:1558812883
Name:MIGUEL, CHRISTINE (RDH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MIGUEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:GRACE FLORES
Other - Last Name:MIGUEL-GREENWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-467-5355
Practice Address - Street 1:3292 PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1517
Practice Address - Country:US
Practice Address - Phone:303-360-6276
Practice Address - Fax:303-467-5355
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002023922124Q00000X
COLOCAL.0000500124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist