Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 6873 | CO |
NPI | 1326046137 |
---|---|
Provider Name | Mr. Kenneth S Lahr |
First Address | Morrison, CO 80465-8902 |
Second Address | Morrison, CO 80465-8902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 08/07/2007 |