Organization
SOUTH ROUTT DENTAL HYGIENE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELINA MARIE HENRY RDH (MEMBER)
(619) 370-5956
Entity
Organization
Contact information
Practice address
300 MAIN STREET, OAK CREEK, CO 80467
(970) 819-9709
(970) 736-2757
Mailing address
PO BOX 658, OAK CREEK, CO 80467-0658
(970) 819-9709
(970) 736-2757
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
905382
CO
Other
Enumeration date
04/27/2009
Last updated
04/27/2009
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