Provider Demographics
NPI:1578772851
Name:KAHL, SHELBY L (RDH)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:KAHL
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 1:1194 W ASH ST STE E
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4608
Mailing Address - Country:US
Mailing Address - Phone:970-686-6899
Mailing Address - Fax:970-686-0889
Practice Address - Street 1:1194 W ASH ST STE E
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4608
Practice Address - Country:US
Practice Address - Phone:970-686-6899
Practice Address - Fax:970-686-0889
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1848124Q00000X
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43558232Medicaid