Individual
PENNY DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2030 LAKE AVE, PUEBLO, CO 81004-3536
(719) 564-4823
Mailing address
2030 LAKE AVE, PUEBLO, CO 81004-3536
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH000903235
CO
Other
Enumeration date
07/30/2015
Last updated
07/30/2015
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