Healthcare Provider Details

I. General information

NPI: 1063935385
Provider Name (Legal Business Name): ZACHARY ALEX KETTLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MAX DR STE 202
CASTLE PINES CO
80108-9519
US

IV. Provider business mailing address

250 MAX DR STE 202
CASTLE PINES CO
80108-9519
US

V. Phone/Fax

Practice location:
  • Phone: 720-733-7799
  • Fax:
Mailing address:
  • Phone: 720-733-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number203266
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00203266
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: