Healthcare Provider Details

I. General information

NPI: 1316618119
Provider Name (Legal Business Name): ALICE KANIFF DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

IV. Provider business mailing address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

V. Phone/Fax

Practice location:
  • Phone: 970-319-2999
  • Fax:
Mailing address:
  • Phone: 970-319-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALICE KANIFF
Title or Position: OWNER
Credential:
Phone: 970-319-2999