Individual
TINA GODISAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
220 E COLORADO AVE STE 106, TELLURIDE, CO 81435
(719) 480-3822
(888) 595-3242
Mailing address
PO BOX 4222, TELLURIDE, CO 81435
(719) 480-3822
(888) 595-3242
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
904579
CO
Other
Enumeration date
10/09/2013
Last updated
10/09/2013
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