Individual
KATHLEEN ELIZABETH WAGUESPACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
9358 DORCHESTER ST, SUITE 106, HIGHLANDS RANCH, CO 80129-5606
(303) 791-4400
Mailing address
9358 DORCHESTER ST, SUITE 106, HIGHLANDS RANCH, CO 80129-5606
(303) 791-4400
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DEN.00201980
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022868
—
OR
01
—
25090
TEXAS BOARD OF DENTAL EXAMINERS
TX
01
—
943096772
TAX ID
—
01
—
D8770
DENTAL LICENSE
OR
01
—
DEN.00201980
DORA
CO
Enumeration date
08/31/2006
Last updated
03/07/2023
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