Provider Demographics
NPI:1750389557
Name:CRICHLOW, KENNETH GREGORY (DD,S,)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GREGORY
Last Name:CRICHLOW
Suffix:
Gender:M
Credentials:DD,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 E TENNESSEE AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1614
Mailing Address - Country:US
Mailing Address - Phone:303-322-9501
Mailing Address - Fax:303-388-1112
Practice Address - Street 1:6795 E TENNESSEE AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:303-322-9501
Practice Address - Fax:303-388-1112
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice