Healthcare Provider Details

I. General information

NPI: 1154047918
Provider Name (Legal Business Name): CDSCD ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S ABILENE CT
AURORA CO
80012-4909
US

IV. Provider business mailing address

151 E 5600 S STE 100
MURRAY UT
84107-8139
US

V. Phone/Fax

Practice location:
  • Phone: 720-361-1112
  • Fax: 720-306-5397
Mailing address:
  • Phone: 801-833-0515
  • Fax: 801-452-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: GARY BRANDON KEHL
Title or Position: MANGAING MEMBER
Credential:
Phone: 801-833-0474