Provider Demographics
NPI:1275785297
Name:CORTESE, KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:CORTESE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 S PIKES PEAK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7389
Mailing Address - Country:US
Mailing Address - Phone:303-841-4580
Mailing Address - Fax:202-841-7765
Practice Address - Street 1:11031 S PIKES PEAK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7389
Practice Address - Country:US
Practice Address - Phone:303-841-4580
Practice Address - Fax:202-841-7765
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice