Allen Kvidera, D.D.S.
Individual provider Active NPI Periodontics · Dillon, CO
NPI 1124128368 · NPPES record last updated Jul 16, 2013
Key facts
- NPI
- 1124128368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 8537 (CO)
- Practice address
- 115 Village Place
Dillon, CO 80435 - Phone
- (563) 940-0751
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8537 | CO | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 8537 | CO | Yes |
Addresses
Primary practice location
115 Village Place
Dillon, CO 80435
Mailing address
PO Box 65
Silverthorne, CO 80498-0065
Phone (563) 940-0751
Other providers in Dillon, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.