Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 8537 | CO |
NPI | 1124128368 |
---|---|
Provider Name | Dr. Allen Kvidera |
First Address | Silverthorne, CO 80498-0065 |
Second Address | Dillon, CO 80435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 16/07/2013 |