Provider Demographics
NPI:1609312131
Name:EAGLE CREEK DENTAL HYGIENE
Entity Type:Organization
Organization Name:EAGLE CREEK DENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-765-6753
Mailing Address - Street 1:226 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4234
Mailing Address - Country:US
Mailing Address - Phone:970-765-6753
Mailing Address - Fax:
Practice Address - Street 1:16061 6250 RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-7887
Practice Address - Country:US
Practice Address - Phone:970-765-6753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000003046124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty