Healthcare Provider Details

I. General information

NPI: 1083619035
Provider Name (Legal Business Name): KELLEY ANN CASEMENT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S COLORADO BLVD STE 320
DENVER CO
80222-3316
US

IV. Provider business mailing address

6601 W 129TH PL APT 206
OVERLAND PARK KS
66209-3882
US

V. Phone/Fax

Practice location:
  • Phone: 303-758-0866
  • Fax:
Mailing address:
  • Phone: 913-322-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8658
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: