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General NPI Number Information
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NPI Number | 1225254774
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Entity Type | Individual
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Provider Name | KENNETH POLKE D.D.S
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 12030 MELODY DR
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City | WESTMINSTER
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State | CO
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Zip | 80234-4212
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Country | US
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Telephone | 720-920-4900
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Fax | 303-280-9357
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Provider Business Mailing Address
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Address Line | 905 W 124TH AVE STE 130
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City | WESTMINSTER
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State | CO
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Zip | 80234-1715
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Country | US
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Telephone | 720-920-4900
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Fax | 303-920-4823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7878
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License Number State | CO
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