Individual
DR. KELLY K. WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1050 W COLFAX AVE STE G, DENVER, CO 80204-2071
(303) 573-5533
(303) 573-5539
Mailing address
1050 W COLFAX AVE STE G, DENVER, CO 80204-2071
(303) 573-5533
(303) 573-5539
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104752
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006994162
UNITED CONCORDIA
CO
01
—
600625
BLUE CROSS BLUE SHIELD
CO
01
—
840947326
EMPLOYER IDENTIFICATION #
CO
Enumeration date
09/14/2006
Last updated
07/08/2007
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