Provider Demographics
NPI:1588108302
Name:QUEZADA-BENCOMO, ANAI (RDH)
Entity type:Individual
Prefix:
First Name:ANAI
Middle Name:
Last Name:QUEZADA-BENCOMO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANAI
Other - Middle Name:
Other - Last Name:BENCOMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2700 GILSTRAP CT STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-8735
Mailing Address - Country:US
Mailing Address - Phone:970-945-2840
Mailing Address - Fax:970-945-2893
Practice Address - Street 1:195 W 14TH STE C
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4717
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:970-945-1055
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024653124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist