Provider Demographics
NPI:1942446786
Name:HEALTHY SMILES DENTAL HYGIENE CARE, INC.
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL HYGIENE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-642-0338
Mailing Address - Street 1:144 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2365
Mailing Address - Country:US
Mailing Address - Phone:970-642-0338
Mailing Address - Fax:
Practice Address - Street 1:144 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2365
Practice Address - Country:US
Practice Address - Phone:970-642-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201441124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22622349Medicaid