Healthcare Provider Details

I. General information

NPI: 1619181666
Provider Name (Legal Business Name): MARK P KINARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 WADSWORTH PKWY
WESTMINSTER CO
80021-6847
US

IV. Provider business mailing address

9920 WADSWORTH PKWY
WESTMINSTER CO
80021-6847
US

V. Phone/Fax

Practice location:
  • Phone: 303-425-1000
  • Fax: 303-425-1026
Mailing address:
  • Phone: 303-425-1000
  • Fax: 303-425-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104117
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: