Provider Demographics
NPI:1861131203
Name:SANTI LOZOYA, CARLY JO (RDH)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:JO
Last Name:SANTI LOZOYA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 DUNHAM ST
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1280
Mailing Address - Country:US
Mailing Address - Phone:719-849-9749
Mailing Address - Fax:
Practice Address - Street 1:403 DUNHAM ST
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1280
Practice Address - Country:US
Practice Address - Phone:719-849-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904486124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist