=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407336738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KESLEY NICOLE SANDERS RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2018
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9351 N. WASHINGTON ST. KIDFIRST CLINIC
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-990-7393
-----------------------------------------------------
Fax | 720-206-0434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11250 FLORENCE ST 28B
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-990-7393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH.002025138
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------