Healthcare Provider Details

I. General information

NPI: 1720073158
Provider Name (Legal Business Name): KEMIE D HOUSTON D.D.S.,M.S.,P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

125 INVERNESS DR E SUITE 300
ENGLEWOOD CO
80112-5137
US

IV. Provider business mailing address

125 INVERNESS DR E SUITE 300
ENGLEWOOD CO
80112-5137
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-5306
  • Fax: 303-779-1822
Mailing address:
  • Phone: 303-779-5306
  • Fax: 303-779-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6881
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: