Organization
PREVENTIVE FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE A HUDDLESTON RDH (PRESIDENT)
(719) 346-7746
Entity
Organization
Contact information
Practice address
1440 LOWELL AVE, BURLINGTON, CO 80807-0094
(719) 346-7746
(719) 346-5360
Mailing address
PO BOX 94, 1440 LOWELL AVE, BURLINGTON, CO 80807-0094
(719) 346-7746
(719) 346-5360
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2986
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21420025
—
CO
05
—
29686873
—
CO
Enumeration date
10/26/2006
Last updated
08/22/2020
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