Provider Demographics
NPI:1033200811
Name:ENDRESS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ENDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14710 W COLFAX AVE UNIT 150
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3277
Mailing Address - Country:US
Mailing Address - Phone:303-279-0999
Mailing Address - Fax:
Practice Address - Street 1:14710 W COLFAX AVE UNIT 150
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3277
Practice Address - Country:US
Practice Address - Phone:303-279-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204446122300000X, 1223G0001X
KS604081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200383350AMedicaid
KS116977OtherBCBS OF KS