Provider Demographics
NPI:1164891545
Name:AMERICAN DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:AMERICAN DENTAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:POLKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-920-4900
Mailing Address - Street 1:905 W 124TH AVE., SUITE #130
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:303-920-4900
Mailing Address - Fax:303-920-4823
Practice Address - Street 1:905 W 124TH AVE STE 130
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1718
Practice Address - Country:US
Practice Address - Phone:303-920-4900
Practice Address - Fax:303-920-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7878305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization