Individual
MS. MARIE L HUSTAFA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
281 SAWYER DR, DURANGO, CO 81303-3409
(970) 247-5702
(970) 247-9126
Mailing address
PO BOX 140, DURANGO, CO 81302-0140
(970) 247-5702
(970) 247-9126
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
904555
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80528201
—
CO
Enumeration date
01/25/2007
Last updated
07/09/2007
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