Provider Demographics
NPI:1265283683
Name:ARCHULETA, KAYLEE (RDH)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:ARCHULETA
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 1:9439 PALLADIUM HTS APT 212D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1552
Mailing Address - Country:US
Mailing Address - Phone:719-821-2904
Mailing Address - Fax:
Practice Address - Street 1:9439 PALLADIUM HTS APT 212D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1552
Practice Address - Country:US
Practice Address - Phone:719-821-2904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002026500124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist