Provider Demographics
NPI: | 1306377213 |
---|---|
Name: | KAELIN PEDIATRIC DENTISTRY |
Entity type: | Organization |
Organization Name: | KAELIN PEDIATRIC DENTISTRY |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KATHRYN |
Authorized Official - Middle Name: | KUTTER |
Authorized Official - Last Name: | KAELIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 303-805-4121 |
Mailing Address - Street 1: | 19700 E PARKER SQUARE DR |
Mailing Address - Street 2: | SUITE 2 |
Mailing Address - City: | PARKER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80134-7301 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-805-8266 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 19700 E PARKER SQUARE DR |
Practice Address - Street 2: | SUITE 2 |
Practice Address - City: | PARKER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80134-7301 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-805-8266 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-03-22 |
Last Update Date: | 2017-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 7329 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |