Provider Demographics
NPI:1508088782
Name:LUEY, KENDRA (RDH)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LUEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 US HIGHWAY 287
Mailing Address - Street 2:STE 200
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7080
Mailing Address - Country:US
Mailing Address - Phone:303-438-9899
Mailing Address - Fax:
Practice Address - Street 1:1140 US HIGHWAY 287
Practice Address - Street 2:STE 200
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7080
Practice Address - Country:US
Practice Address - Phone:303-438-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905242124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist