Individual
MAELISA B RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
245 VINE AVE, LAS ANIMAS, CO 81054-1039
(719) 456-2653
Mailing address
245 VINE AVE, LAS ANIMAS, CO 81054-1039
(719) 456-2653
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2025220
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2025220
LICENSURE
CO
Enumeration date
03/01/2021
Last updated
03/01/2021
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