Provider Demographics
NPI:1154047918
Name:CDSCD ANESTHESIA
Entity type:Organization
Organization Name:CDSCD ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGAING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:KEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-833-0474
Mailing Address - Street 1:151 E 5600 S STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8139
Mailing Address - Country:US
Mailing Address - Phone:801-833-0515
Mailing Address - Fax:801-452-6748
Practice Address - Street 1:1111 S ABILENE CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4909
Practice Address - Country:US
Practice Address - Phone:720-361-1112
Practice Address - Fax:720-306-5397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE DENTAL SURGICAL CENTER OF DENVER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty