Provider Demographics
NPI:1083318554
Name:ADAIME, SHANIE MARIE (RDH)
Entity type:Individual
Prefix:
First Name:SHANIE
Middle Name:MARIE
Last Name:ADAIME
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:SHANIE
Other - Middle Name:MARIE
Other - Last Name:ADAIME ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:303-436-6328
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-436-6328
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLOCAL.0001665124Q00000X
CODH.002025355124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist