Provider Demographics
NPI:1851752554
Name:WORTHINGTON, EVIN ELISABETH
Entity Type:Individual
Prefix:DR
First Name:EVIN
Middle Name:ELISABETH
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EVIN
Other - Middle Name:ELISABETH
Other - Last Name:WORTHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1565 RALEIGH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1485
Mailing Address - Country:US
Mailing Address - Phone:970-903-8787
Mailing Address - Fax:
Practice Address - Street 1:200 QUEBEC ST BLDG 500-105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7150
Practice Address - Country:US
Practice Address - Phone:303-364-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02030781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice