Provider Demographics
NPI:1972501369
Name:CARLSON, KENDAL NYLAS (DMD)
Entity Type:Individual
Prefix:
First Name:KENDAL
Middle Name:NYLAS
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 FOXRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7826
Mailing Address - Country:US
Mailing Address - Phone:720-320-1425
Mailing Address - Fax:
Practice Address - Street 1:155 COOK ST
Practice Address - Street 2:SUITE 141
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5325
Practice Address - Country:US
Practice Address - Phone:303-355-2373
Practice Address - Fax:303-333-5958
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00160001223G0001X
COHD-16000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice