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NPI Code Detail

MEDICARE: KEVIN HERTICH DDS

MEDICARE: KEVIN HERTICH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodonticsDEN.00203362CO

General Provider Information

NPI Number : 1083207450
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN HERTICH DDS
Provider Business Mailing Address
First Line : 4257 MARIPOSA ST
Second Line :
City : DENVER
State : CO
Zip : 80211-2530
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12999 W BOWLES DR
Second Line :
City : LITTLETON
State : CO
Zip : 80127-4641
Country : US
Telephone Number : 720-513-1193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2021
Last Update Date : 02/17/2021

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