Provider Demographics
NPI:1225254774
Name:POLKE, KENNETH (DDS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:POLKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W 124TH AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1715
Mailing Address - Country:US
Mailing Address - Phone:720-920-4900
Mailing Address - Fax:303-920-4823
Practice Address - Street 1:12030 MELODY DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-4212
Practice Address - Country:US
Practice Address - Phone:720-920-4900
Practice Address - Fax:303-280-9357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist