=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477018232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KANTOR DENTAL GROUP 2, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2019
-----------------------------------------------------
Last Update Date | 09/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11979 HOLLY ST
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-739-0047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10723 FAIRGROVE CT
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80126-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-270-0903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIC APPELSIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-270-0903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------