Individual
PARKER THEODORE KASTELIC I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2124 FREEDOM RD, TRINIDAD, CO 81082-1210
(719) 422-5696
Mailing address
403 N COMMERCIAL ST APT 201, TRINIDAD, CO 81082-1903
(920) 838-2258
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00204748
CO
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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