Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DEN.00203362 | CO |
NPI | 1083207450 |
---|---|
Provider Name | Kevin Hertich |
First Address | Denver, CO 80211-2530 |
Second Address | Littleton, CO 80127-4641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2021 |
Last Update Date | 17/02/2021 |