Provider Demographics
NPI:1972703494
Name:GHIGLERI, LAURIE KAY (BS, RDH)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:KAY
Last Name:GHIGLERI
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 MCEWAN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3126
Mailing Address - Country:US
Mailing Address - Phone:719-634-0687
Mailing Address - Fax:719-622-0308
Practice Address - Street 1:7155 MCEWAN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3126
Practice Address - Country:US
Practice Address - Phone:719-634-0687
Practice Address - Fax:719-622-0308
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904682124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87308037Medicaid