Provider Demographics
NPI:1629503669
Name:EARLY ORAL HEALTH INTERCEPTION LLC
Entity Type:Organization
Organization Name:EARLY ORAL HEALTH INTERCEPTION LLC
Other - Org Name:SLV GLOBAL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCISCO-MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:720-206-9031
Mailing Address - Street 1:1229 S VERBENA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-3089
Mailing Address - Country:US
Mailing Address - Phone:720-206-9031
Mailing Address - Fax:
Practice Address - Street 1:235 CARSON AVENUE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101
Practice Address - Country:US
Practice Address - Phone:720-206-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904246124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty