Healthcare Provider Details

I. General information

NPI: 1952556722
Provider Name (Legal Business Name): KANANI COLEMAN RDH, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 POTOMAC ST STE L23
AURORA CO
80011-6742
US

IV. Provider business mailing address

1150 INCA ST APT 19
DENVER CO
80204-3565
US

V. Phone/Fax

Practice location:
  • Phone: 303-360-8811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number904270
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: