Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 00201856 | CO |
N | 1223D0004X | Dentist Anesthesiologist | 8590166-9924 | UT |
NPI | 1003173576 |
---|---|
Provider Name | Dr. Joshua Jackstien |
First Address | Greenwood Village, CO 80111-2990 |
Second Address | Greenwood Village, CO 80111-2990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 14/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13430734 | (05) | CO |