Provider Demographics
NPI:1306125950
Name:RANKIN, THERESA (RDH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:RANKIN
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:PO BOX 775386
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-5386
Mailing Address - Country:US
Mailing Address - Phone:970-879-9828
Mailing Address - Fax:970-879-9858
Practice Address - Street 1:1560 PINE GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:980-879-9828
Practice Address - Fax:970-879-9858
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904813124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist