Provider Demographics
NPI:1720485345
Name:NORTHERN COLORADO DENTAL HYGIENE LLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-599-8245
Mailing Address - Street 1:4575 OBRIEN DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6400
Mailing Address - Country:US
Mailing Address - Phone:970-599-8245
Mailing Address - Fax:
Practice Address - Street 1:4575 OBRIEN DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-6400
Practice Address - Country:US
Practice Address - Phone:970-599-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2791124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty