MEDICARE: KATHLEEN E FAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	00204841	CO

General Provider Information

NPI Number	:	1215601257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN E FAY

Provider Business Mailing Address
First Line	:	1633 N PEARL ST APT 424
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1644
Country	:	US
Telephone Number	:	913-544-7876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2780 S BROADWAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-1523
Country	:	US
Telephone Number	:	303-783-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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Directions to “ KATHLEEN E FAY ” Practice Location

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