Individual
JACIE HOMM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2322 SAN JUAN AVE, LA JUNTA, CO 81050-3341
(719) 383-3939
Mailing address
2322 SAN JUAN AVE, LA JUNTA, CO 81050-3341
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
905307
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58300783
—
CO
Enumeration date
07/24/2008
Last updated
07/24/2008
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