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General NPI Number Information
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NPI Number | 1598988339
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Entity Type | Individual
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Provider Name | KENNETH VAUGHN WADSWORTH DDS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11290 W ALAMEDA AVE #205
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City | LAKEWOOD
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State | CO
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Zip | 80226-2576
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Country | US
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Telephone | 303-985-9850
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Fax | 303-985-5827
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Provider Business Mailing Address
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Address Line | 5088 S PERRY PARK RD
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City | SEDALIA
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State | CO
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Zip | 80135-8209
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Country | US
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Telephone | 303-681-3681
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 805
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License Number State | CO
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