Provider Demographics
NPI:1245440098
Name:GUENTHNER, HAVENS ANN (RDH)
Entity type:Individual
Prefix:
First Name:HAVENS
Middle Name:ANN
Last Name:GUENTHNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 IMPALA TRL
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2121
Mailing Address - Country:US
Mailing Address - Phone:303-523-2851
Mailing Address - Fax:
Practice Address - Street 1:26697 PLEASANT PARK RD
Practice Address - Street 2:#120
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7732
Practice Address - Country:US
Practice Address - Phone:303-523-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903771124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05835241Medicaid