Healthcare Provider Details

I. General information

NPI: 1972501369
Provider Name (Legal Business Name): KENDAL NYLAS CARLSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 COOK ST SUITE 141
DENVER CO
80206-5325
US

IV. Provider business mailing address

10209 FOXRIDGE CIR
HIGHLANDS RANCH CO
80126-7826
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-2373
  • Fax: 303-333-5958
Mailing address:
  • Phone: 720-320-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberHD-16000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.0016000
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: