Organization
BRILLIANT SMILES DENTAL HYGIENE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER D KENDALL RDH (OWNER)
(970) 527-5100
Entity
Organization
Contact information
Practice address
87 HIGHWAY 133, PAONIA, CO 81428
(970) 527-5100
(970) 527-5101
Mailing address
PO BOX 1173, PAONIA, CO 81428-1173
(970) 527-5100
(970) 527-5101
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
903219
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366844557
NPI INDIVIDUAL
CO
Enumeration date
12/01/2014
Last updated
12/01/2014
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