Individual
DOMINOE NICHOLE BANUELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DH
Contact information
Practice address
3705 E COLFAX AVE UNIT 101, DENVER, CO 80206-1810
(303) 399-3001
Mailing address
18159 E 44TH AVE, DENVER, CO 80249-7602
(303) 669-0624
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
002025261
CO
Other
Enumeration date
09/29/2018
Last updated
09/29/2018
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