Provider Demographics
NPI:1316526379
Name:DIETIKER, KEVIN (DDS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:DIETIKER
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 1:877 E SOUTH BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1345
Mailing Address - Country:US
Mailing Address - Phone:303-665-8228
Mailing Address - Fax:303-200-7375
Practice Address - Street 1:877 E SOUTH BOULDER RD # RX
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1345
Practice Address - Country:US
Practice Address - Phone:303-665-8228
Practice Address - Fax:303-200-7375
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002049891223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice