Provider Demographics
NPI:1841539467
Name:CASPER, PAULA JO (RDH, BLS)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JO
Last Name:CASPER
Suffix:
Gender:F
Credentials:RDH, BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LARIAT LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9475
Mailing Address - Country:US
Mailing Address - Phone:970-948-2615
Mailing Address - Fax:
Practice Address - Street 1:51241 HIGHWAY 6
Practice Address - Street 2:SUITE #5
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-2588
Practice Address - Country:US
Practice Address - Phone:970-945-2313
Practice Address - Fax:970-945-5505
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902931124Q00000X
FLDH7728124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist