Healthcare Provider Details

I. General information

NPI: 1760489660
Provider Name (Legal Business Name): FATIMA KAZI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA KAZI LEE D.D.S.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W 29TH AVE
WHEAT RIDGE CO
80033-8002
US

IV. Provider business mailing address

3701 S BROADWAY
ENGLEWOOD CO
80113-3611
US

V. Phone/Fax

Practice location:
  • Phone: 303-239-9964
  • Fax: 303-237-4343
Mailing address:
  • Phone: 303-360-6276
  • Fax: 303-467-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00008299
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: