Individual
MARIANNE WANCURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
124 E 4TH ST, SALIDA, CO 81201-2616
(719) 539-2224
Mailing address
124 E 4TH ST, SALIDA, CO 81201-2616
(719) 539-2224
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
COHD200382
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24984531
—
CO
01
—
COTP123536A
TRADING PARTNER ID
CO
Enumeration date
10/19/2006
Last updated
07/09/2007
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