Provider Demographics
NPI:1043576242
Name:KT DENTAL LLC
Entity Type:Organization
Organization Name:KT DENTAL LLC
Other - Org Name:DK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUY KHIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG XUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-524-3959
Mailing Address - Street 1:95 S SHERIDAN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2445
Mailing Address - Country:US
Mailing Address - Phone:720-524-3959
Mailing Address - Fax:720-596-4482
Practice Address - Street 1:95 S SHERIDAN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2445
Practice Address - Country:US
Practice Address - Phone:720-524-3959
Practice Address - Fax:720-596-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8352261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental