Provider Demographics
NPI:1851547202
Name:DERRYBERRY, CYNTHIA (RDH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DERRYBERRY
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 1:2465 S DOWNING ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-733-3710
Mailing Address - Fax:303-733-3670
Practice Address - Street 1:2465 S DOWNING ST STE 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-733-3710
Practice Address - Fax:303-733-3670
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH902794124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist