1720073158 NPI number — KEMIE D HOUSTON D.D.S.,M.S.,P.C.

Table of content: KEMIE D HOUSTON D.D.S.,M.S.,P.C. (NPI 1720073158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720073158 NPI number — KEMIE D HOUSTON D.D.S.,M.S.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSTON
Provider First Name:
KEMIE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.,M.S.,P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720073158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
03/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 INVERNESS DR E
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-5137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-779-5306
Provider Business Mailing Address Fax Number:
303-779-1822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 INVERNESS DR E
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-5137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-779-5306
Provider Business Practice Location Address Fax Number:
303-779-1822
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  6881 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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