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Provider Information for 1619132818

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1619132818

Calendar   Last Updated:  2010-12-28
  Certification Date: 


Name Value
NPI 1619132818
Enumeration Date 2008-07-28
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 201 W 8TH ST SUITE 810
PUEBLO, CO 81003-3038
United States

Phone: 719-562-4447 | Fax:
View Map External Link
Primary Practice Address 3050 MARTIN LUTHER KING JR DR SW
ATLANTA, GA 30311-1500
United States

Phone: 404-696-3163 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice GA DN013812
No 1223G0001X - Dentist General Practice IL 019027769