MEDICARE: CARBON VALLEY DENTAL COMPANY LLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1730904715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARBON VALLEY DENTAL COMPANY LLC

Provider Business Mailing Address
First Line	:	12801 LAFAYETTE ST UNIT D202
Second Line	:
City	:	THORNTON
State	:	CO
Zip	:	80241-1810
Country	:	US
Telephone Number	:	210-845-7601
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 COLORADO BLVD UNIT 150
Second Line	:
City	:	FIRESTONE
State	:	CO
Zip	:	80504-6803
Country	:	US
Telephone Number	:	210-845-7601
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE PATRICK WALKER
Credential	:	DDS
Telephone Number	:	210-845-7601

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	11/22/2024

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Directions to “CARBON VALLEY DENTAL COMPANY LLC ” Practice Location

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