Provider Demographics
NPI:1255967626
Name:POWERS, ROXANNE KAY (RDH,MA)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:KAY
Last Name:POWERS
Suffix:
Gender:F
Credentials:RDH,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 COLLINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1566
Mailing Address - Country:US
Mailing Address - Phone:970-481-6292
Mailing Address - Fax:
Practice Address - Street 1:705 COLLINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1566
Practice Address - Country:US
Practice Address - Phone:970-481-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000002567124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist