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General NPI Number Information
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NPI Number | 1154047918
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Entity Type | Organization
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Legal Business Name | CDSCD ANESTHESIA
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 1111 S ABILENE CT
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City | AURORA
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State | CO
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Zip | 80012-4909
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Country | US
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Telephone | 720-361-1112
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Fax | 720-306-5397
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Provider Business Mailing Address
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Address Line | 151 E 5600 S STE 100
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City | MURRAY
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State | UT
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Zip | 84107-8139
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Country | US
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Telephone | 801-833-0515
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Fax | 801-452-6748
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Authorized Official
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Title or Position | MANGAING MEMBER
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Name | GARY BRANDON KEHL
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Credential |
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Telephone | 801-833-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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