Provider Demographics
NPI:1053716308
Name:REWERTS, MICHELE (RDH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:REWERTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:PROPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-350-4606
Mailing Address - Fax:970-350-4692
Practice Address - Street 1:302 3RD ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6419
Practice Address - Country:US
Practice Address - Phone:970-461-8942
Practice Address - Fax:970-292-1538
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2023953124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75750341Medicaid