Provider Demographics
NPI:1689852089
Name:KENNETH M. DIXEY
Entity Type:Organization
Organization Name:KENNETH M. DIXEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-841-5313
Mailing Address - Street 1:10521 S PARKER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9082
Mailing Address - Country:US
Mailing Address - Phone:303-841-5313
Mailing Address - Fax:303-841-5557
Practice Address - Street 1:10521 S PARKER RD
Practice Address - Street 2:SUITE E
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9082
Practice Address - Country:US
Practice Address - Phone:303-841-5313
Practice Address - Fax:303-841-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty