Healthcare Provider Details

I. General information

NPI: 1922062546
Provider Name (Legal Business Name): ANTHONY C KARDELIS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 W JEFFERSON AVE #404
LAKEWOOD CO
80235-2038
US

IV. Provider business mailing address

7373 W JEFFERSON AVE
LAKEWOOD CO
80235-2021
US

V. Phone/Fax

Practice location:
  • Phone: 303-986-2765
  • Fax: 303-986-2767
Mailing address:
  • Phone: 303-986-2765
  • Fax: 303-986-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8418
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8418
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: