Provider Demographics
NPI:1427427384
Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Entity type:Organization
Organization Name:STATE BOARD FOR COMMUNITY COLLEGES AND OCCUPATIONAL EDUCATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-365-8334
Mailing Address - Street 1:1062 AKRON WAY
Mailing Address - Street 2:BLDG 753
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7102
Mailing Address - Country:US
Mailing Address - Phone:303-365-8340
Mailing Address - Fax:
Practice Address - Street 1:1062 AKRON WAY
Practice Address - Street 2:BLDG 753
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7102
Practice Address - Country:US
Practice Address - Phone:303-365-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905071261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental