Organization
JEANNE GRAVES
Active
Other names
Dental Hygiene Services
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE GRAVES R.D.H. (OWNER)
(719) 542-2489
Entity
Organization
Contact information
Practice address
2099 W. US HWY 50, SUITE #180, PUEBLO, CO 81008-1673
(719) 542-2489
Mailing address
2099 W. US HWY 50, SUITE #180, PUEBLO, CO 81008-1673
(719) 542-2489
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04014437
—
CO
Enumeration date
10/21/2014
Last updated
10/21/2014
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