Provider Demographics
NPI:1316594740
Name:DOUGLAS, KIRA UNGER (DMD)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:UNGER
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 TELLURIDE PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7219
Mailing Address - Country:US
Mailing Address - Phone:303-945-6258
Mailing Address - Fax:
Practice Address - Street 1:811 BRICKYARD CIR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8058
Practice Address - Country:US
Practice Address - Phone:720-251-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002058471223D0004X
WA60970413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist