Healthcare Provider Details

I. General information

NPI: 1467018812
Provider Name (Legal Business Name): KYLEE MARTIN RHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W 38TH AVE STE 50
DENVER CO
80211-2000
US

IV. Provider business mailing address

4144 VALLEJO ST
DENVER CO
80211-1823
US

V. Phone/Fax

Practice location:
  • Phone: 303-515-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: