NPIMap

Organization Active NPI

Preventive Family Dental PC

  • Dental Hygienist
  • Burlington, CO
National Provider Identifier
1366527400
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
2986 Issued in CO
Legal business name
PREVENTIVE FAMILY DENTAL PC
Practice address
1440 Lowell Ave
Burlington, CO 80807-0094
Phone
(719) 346-7746
Fax
(719) 346-5360
NPI assigned
Oct 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Julie A Huddleston, RDHNPI 1104958644
Title
President
Phone
(719) 346-7746

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 2986 CO Primary

Addresses

Primary practice location

1440 Lowell Ave
Burlington, CO 80807-0094

Mailing address

PO Box 94
1440 Lowell Ave
Burlington, CO 80807-0094
Phone (719) 346-7746

Other identifiers 2

IdentifierTypeStateIssuer
21420025MedicaidCO
29686873MedicaidCO

National Provider Directory

National Provider Directory

Locations

1440 Lowell Ave
Burlington, CO 80807
Phone (719) 346-7746

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366527400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "address_2": "1440 LOWELL AVE",
            "city": "BURLINGTON",
            "state": "CO",
            "postal_code": "808070094",
            "telephone_number": "719-346-7746",
            "fax_number": "719-346-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 LOWELL AVE",
            "city": "BURLINGTON",
            "state": "CO",
            "postal_code": "808070094",
            "telephone_number": "719-346-7746",
            "fax_number": "719-346-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE FAMILY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUDDLESTON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-346-7746",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CO",
            "license": "2986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21420025",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29686873",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.