Provider Demographics
NPI:1205075363
Name:EAGLE BEND DENTAL HYGIENE,LLC
Entity type:Organization
Organization Name:EAGLE BEND DENTAL HYGIENE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-617-0303
Mailing Address - Street 1:22651 E AURORA PKWY UNIT A5
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6086
Mailing Address - Country:US
Mailing Address - Phone:303-617-0303
Mailing Address - Fax:303-617-0603
Practice Address - Street 1:22651 E AURORA PKWY UNIT A5
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-6086
Practice Address - Country:US
Practice Address - Phone:303-617-0303
Practice Address - Fax:303-617-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2244124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty