Provider Demographics
NPI:1619916160
Name:GASPER, KEN II (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:GASPER
Suffix:II
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 1:8610 EXPLORER DR
Mailing Address - Street 2:STE. 315
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1058
Mailing Address - Country:US
Mailing Address - Phone:719-599-0700
Mailing Address - Fax:719-599-8745
Practice Address - Street 1:8610 EXPLORER DR
Practice Address - Street 2:STE. 315
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1058
Practice Address - Country:US
Practice Address - Phone:719-599-0700
Practice Address - Fax:719-599-8745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist