Provider Demographics
NPI:1104892066
Name:DIXEY, KENNETH M (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:DIXEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17167 CEDAR GULCH PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4411
Mailing Address - Country:US
Mailing Address - Phone:303-841-5313
Mailing Address - Fax:303-841-5557
Practice Address - Street 1:17167 CEDAR GULCH PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4411
Practice Address - Country:US
Practice Address - Phone:303-841-5313
Practice Address - Fax:303-841-5557
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice