Provider Demographics
NPI:1831581024
Name:KIDS DENTAL HYGIENE, LLC
Entity type:Organization
Organization Name:KIDS DENTAL HYGIENE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BORIA
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:719-221-5273
Mailing Address - Street 1:PO BOX 4040
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-4040
Mailing Address - Country:US
Mailing Address - Phone:719-395-9048
Mailing Address - Fax:719-395-9064
Practice Address - Street 1:28374 COUNTY ROAD 317
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9158
Practice Address - Country:US
Practice Address - Phone:719-395-9048
Practice Address - Fax:719-395-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000201412124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty