Provider Demographics
NPI:1720439359
Name:KENNETH O GASPER II DDS PC
Entity Type:Organization
Organization Name:KENNETH O GASPER II DDS PC
Other - Org Name:AESTHETIC DENTISTRY BY DESIGN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:GASPER
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-599-0700
Mailing Address - Street 1:8610 EXPLORER DR
Mailing Address - Street 2:#315
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
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:#315
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-599-0700
Practice Address - Fax:719-599-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty