Healthcare Provider Details

I. General information

NPI: 1649118928
Provider Name (Legal Business Name): MACKENZIE KNIESCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 W HOLDEN PL
DENVER CO
80204-3353
US

IV. Provider business mailing address

1360 W CUSTER PL
DENVER CO
80223-2321
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-6600
  • Fax:
Mailing address:
  • Phone: 719-428-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002025691
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: