Individual
SUSAN MARIE SHADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
9197 GRANT ST, THORNTON, CO 80229-4361
(303) 358-6092
Mailing address
11470 PARIS ST, HENDERSON, CO 80640-7614
(303) 358-6092
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH903675
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20081649099
STATE IDENTIFICATION NUMBER
CO
Enumeration date
01/01/2009
Last updated
01/01/2009
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