Provider Demographics
NPI:1073974127
Name:LUNKA, KYLIE RAE (DH)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:RAE
Last Name:LUNKA
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 S MONACO ST
Mailing Address - Street 2:UNIT 4035
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3490
Mailing Address - Country:US
Mailing Address - Phone:720-581-2871
Mailing Address - Fax:
Practice Address - Street 1:4380 S MONACO ST
Practice Address - Street 2:UNIT 4035
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-3490
Practice Address - Country:US
Practice Address - Phone:720-581-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024375124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist