Provider Demographics
NPI:1699984864
Name:KLEPACKI, KYLE ANTON (DDS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANTON
Last Name:KLEPACKI
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 1:1070 SOUTHBURY PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1804
Mailing Address - Country:US
Mailing Address - Phone:414-403-5489
Mailing Address - Fax:303-779-1822
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-779-5306
Practice Address - Fax:303-779-1822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101451223P0221X
WI61411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice