Provider Demographics
NPI:1922405398
Name:IN HOME DENTAL OF NORTHERN COLORADO
Entity Type:Organization
Organization Name:IN HOME DENTAL OF NORTHERN COLORADO
Other - Org Name:IN HOME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERCIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-686-1183
Mailing Address - Street 1:651 BABINE CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3179
Mailing Address - Country:US
Mailing Address - Phone:970-686-1183
Mailing Address - Fax:970-674-8090
Practice Address - Street 1:651 BABINE CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3179
Practice Address - Country:US
Practice Address - Phone:970-686-1183
Practice Address - Fax:970-674-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2023596124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty