Provider Demographics
NPI:1720254980
Name:LOUISE A MARTIN RDH, LLC
Entity type:Organization
Organization Name:LOUISE A MARTIN RDH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:ADRIENNE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:303-548-3568
Mailing Address - Street 1:11180 W TENNESSEE CRT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226
Mailing Address - Country:US
Mailing Address - Phone:303-548-3568
Mailing Address - Fax:303-988-5819
Practice Address - Street 1:727 SIMMS ST
Practice Address - Street 2:SUITE E
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-4792
Practice Address - Country:US
Practice Address - Phone:303-232-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2631124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty