Provider Demographics
NPI:1548375975
Name:BROWER, KATHLEEN C (DDS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:BROWER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S ACADEMY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-2479
Mailing Address - Country:US
Mailing Address - Phone:719-380-5733
Mailing Address - Fax:719-380-5537
Practice Address - Street 1:2130 S ACADEMY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2479
Practice Address - Country:US
Practice Address - Phone:719-380-5733
Practice Address - Fax:719-380-5537
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO67001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO432006564OtherTIN