Provider Demographics
NPI:1306426218
Name:HOSBURGH, JENNIFER L (RDH, OMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HOSBURGH
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 REDFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9210
Mailing Address - Country:US
Mailing Address - Phone:321-720-5761
Mailing Address - Fax:
Practice Address - Street 1:2132 REDFIELD CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-9210
Practice Address - Country:US
Practice Address - Phone:321-720-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH002024040124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty