Provider Demographics
NPI:1710073424
Name:DASH, KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:
Last Name:DASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 RESEARCH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1094
Mailing Address - Country:US
Mailing Address - Phone:719-535-9990
Mailing Address - Fax:719-535-9980
Practice Address - Street 1:2438 RESEARCH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1094
Practice Address - Country:US
Practice Address - Phone:719-535-9990
Practice Address - Fax:719-535-9980
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42829208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05951356Medicaid
CO200485127OtherTIN
CO534988Medicare ID - Type UnspecifiedMEDICARE GROUP
CO05951356Medicaid