Provider Demographics
NPI:1982449682
Name:CROSSFIELD, KACEY JADE (DDS)
Entity type:Individual
Prefix:DR
First Name:KACEY
Middle Name:JADE
Last Name:CROSSFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 BRIAN AVE UNIT 25052
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80497-1944
Mailing Address - Country:US
Mailing Address - Phone:870-634-6071
Mailing Address - Fax:
Practice Address - Street 1:354 BLUE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80497
Practice Address - Country:US
Practice Address - Phone:970-262-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00206023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist