Healthcare Provider Details

I. General information

NPI: 1710073424
Provider Name (Legal Business Name): KRISHNA DASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 RESEARCH PKWY STE 100
COLORADO SPRINGS CO
80920-1094
US

IV. Provider business mailing address

2438 RESEARCH PKWY STE 100
COLORADO SPRINGS CO
80920-1094
US

V. Phone/Fax

Practice location:
  • Phone: 719-535-9990
  • Fax: 719-535-9980
Mailing address:
  • Phone: 719-535-9990
  • Fax: 719-535-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number42829
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: