Provider Demographics
NPI:1831329168
Name:ZACCAGNINI, KATHLEEN (RDH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ZACCAGNINI
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 1:8500 W BOWLES AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3276
Mailing Address - Country:US
Mailing Address - Phone:303-972-2988
Mailing Address - Fax:303-979-2004
Practice Address - Street 1:8500 W BOWLES AVE STE 305
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3276
Practice Address - Country:US
Practice Address - Phone:303-972-2988
Practice Address - Fax:303-979-2004
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH-200708124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist