Individual
THERESA LYNN MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
691 E EMPIRE ST, CORTEZ, CO 81321-2802
(970) 565-7946
Mailing address
150 MERCURY VILLAGE DR, DURANGO, CO 81301-8955
(970) 335-2422
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH.002024081
CO
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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