Provider Demographics
NPI:1023420239
Name:GERIATRIC DENTAL HYGIENE SERVICES
Entity type:Organization
Organization Name:GERIATRIC DENTAL HYGIENE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JIANNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-422-3175
Mailing Address - Street 1:11577 W 38TH PL
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3803
Mailing Address - Country:US
Mailing Address - Phone:303-422-3175
Mailing Address - Fax:303-940-4911
Practice Address - Street 1:11577 W 38TH PL
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3803
Practice Address - Country:US
Practice Address - Phone:303-422-3175
Practice Address - Fax:303-940-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201274124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1649417247OtherPROVIDER NPI NUMBER