Individual
JOHANA L MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
0405 CASTLE CREEK RD, ASPEN, CO 81611
(970) 929-5420
Mailing address
345 COLUMBINE DR, RIFLE, CO 81650-9353
(970) 274-1146
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
002024469
CO
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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