Individual
DR. MARILYN VIGIL KETCHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3800 YORK ST, DENVER, CO 80205-3540
(303) 296-4873
Mailing address
3800 YORK ST, DENVER, CO 80205-3540
(303) 296-4873
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6990
CO
122300000X
Dentist
DD2546
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02069904
—
CO
01
—
6990
COLORADO DENTAL LICENSE
CO
05
—
87384043
—
NM
01
—
CS00210277
BOARD OF PHARMACY NUMBER
NM
01
—
DD2546
DENTAL STATE LICENSE
NM
Enumeration date
09/16/2006
Last updated
09/06/2011
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