Provider Demographics
NPI:1821339508
Name:MARTIN, PATRICIA FRANCIS (RDH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FRANCIS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:FRANCIS
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1345 PLAZA CT N STE 1A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2832
Mailing Address - Country:US
Mailing Address - Phone:303-665-3036
Mailing Address - Fax:
Practice Address - Street 1:2525 13TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4104
Practice Address - Country:US
Practice Address - Phone:303-449-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist